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Outcomes of catheter ablation of ventricular tachycardia with mechanical hemodynamic support: An analysis of the Medicare database
Author(s) -
Aryana Arash,
d'Avila André,
Cool Christina L.,
Miller Marc A.,
Garcia Fermin C.,
Supple Gregory E.,
Dukkipati Srinivas R.,
Lakkireddy Dhanunjaya,
Bunch T. Jared,
Bowers Mark R.,
O'Neill Padraig Gearoid,
Reddy Vivek Y.,
Marchlinski Francis E.
Publication year - 2017
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13312
Subject(s) - medicine , cardiogenic shock , cardiology , heart failure , ventricular tachycardia , ablation , catheter ablation , incidence (geometry) , ventricular assist device , database , myocardial infarction , physics , computer science , optics
There is a paucity of data in favor of mechanical support during catheter ablation of ventricular tachycardia (VT). This study investigated the outcomes of VT ablation associated with mechanical support using percutaneous ventricular assist device (PVAD) versus intra‐aortic balloon pump (IABP). Methods and results We retrospectively examined the outcomes of patients who underwent VT ablation associated with PVAD versus IABP from 2010 to 2013, captured by the Medicare Inpatient Standard Analytic File database. Data from 345 patients (PVAD = 230, IABP = 115) were examined. On admission, the incidence of heart failure was higher in PVAD (84.3% vs. 73.0%; P = 0.01) with similar rates of renal failure in PVAD versus IABP (33.0% vs. 37.4%; P = 0.42). However, PVAD was associated with reduced in‐hospital cardiogenic shock (9.1% vs. 23.5%; P < 0.001), renal failure (11.7% vs. 21.7%; P = 0.01), and length of stay (8.4 ± 7.9 vs. 10.6 ± 7.5; P < 0.001), but with greater hospital discharges to home/self‐care (66.0% vs. 51.6%; P = 0.02). Index mortality (6.5% vs. 19.1%; P = 0.001) and mortality in patients with cardiogenic shock (18.2% vs. 41.2%; P = 0.03) were significantly lower with PVAD versus IABP. Furthermore, PVAD was associated with lower all‐cause (27.0% vs. 38.7%; P = 0.04) and heart failure‐related (21.4% vs. 33.3%; P = 0.03) 30‐day hospital readmissions, but with similar redo‐VT ablation rates at 1 year (10.2% vs. 14.0%; P = 0.34). Conclusion Among the cases captured by the Medicare database, catheter ablation of VT associated with mechanical support using PVAD was associated with reduced in‐hospital cardiogenic shock, renal failure, length of stay, hospital readmissions and mortality, but no difference in redo‐VT ablation at 1 year.