Summary of main studies reporting outcomes following use of mechanical circulatory support devices during ventricular tachycardia ablation
| Study . | Design . | Patients . | Haemodynamic support . | Aetiologies . | Duration of follow-up . | Short-term outcome . | Long-term outcome . |
|---|---|---|---|---|---|---|---|
| Reddy 2014 | Prospective, multi-centre registry | 66 | IABP (n. 22), Impella 2.5 (n. 25), and Tandem Heart (n. 19) | 70% IHD, 30% NIDC | 12 ± 5 months | Compared to IABP, although with the use of Impella or Tandem Heart, more unstable VTs were mapped (1.05 vs. 0.32; P < 0.001) and a greater number of VTs was terminated (1.59 vs. 0.91; P = 0.007), periprocedural success and complications were similar. | Compared to IABP, Impella, and TandemHeart cohort had similar VT recurrence (42% vs. 50%) and mortality (36% in both). |
| Baratto 2016 | Retrospective, single-centre | 64 | ECMO (n. 64) | 45% IHD, 55% NIDC | 23 ± 13 months | No inducible VT achieved in 69%. In-hospital mortality was 1.5%. Major complications included acute kidney injury (6%), vascular injury (3%), and acute heart failure (8%). | At follow-up, VT recurred in 33%, overall mortality was 12%, and rate of transplantation was 9%. Transplant and LVAD-free survival was 69%. |
| Turagam 2017 | Retrospective, multicentre study (International VT Ablation Center Collaborative group) | 105 | Impella 2.5 ECMO Tandem Heart | 60% IHD, 40% NIDC | 527 days (208–1048) | Compared to 1550 undergoing VT ablation without HS, patients in the HS group were sicker, acute procedural success was lower and complications higher. | One-year mortality was significantly higher in the HS group. The use of HS was an independent predictor of mortality. However, in patients with LVEF <20% and NYHA functional Class III to IV, there was also no significant difference in clinical outcomes when compared with no HS. |
| Aryana 2017 | Retrospective analysis of US Medicare database | 345 | PVAD (not reported if Impella, ECMO or Tandem Heart) (n. 230), IABP (n. 115) | 60% IHD, 40% NIDCM | >12 months | Compared to IABP, PVAD was associated with reduced mortality (6.5% vs. 19.1%), cardiogenic shock (9.1% vs. 23.5%), acute kidney injury (11.7% vs. 21.7%), 30-day re-hospitalization (27.0% vs. 37.8%), and shorter hospital LOS (8.4 vs. 10.6 days). | PVAD group had similar re- do VT ablation rates at 1-year, compared with IABP (10.2% vs. 14.0%; P = 0.34). |
| Kusa 2017 | Retrospective, single-centre, PM | 194 | Impella 2.5 (n. 80), Impella CP (n. 29), control (n. 85)a | 57% IHD; 4% NIDCM | 7.17 months | In PM analysis, procedure duration was longer in Impella group but no significant difference in VT inducibility at procedure end (14% vs. 10%; P = 0.43) and complications (11% vs. 3%; P = 0.18) or hospital LOS. | No significant difference between Impella and control group in PM analysis for mortality (5% vs. 8%; P = 0.50), transplantation (5% vs. 0%; P = 0.25) or recurrent VT (26% vs. 21%; P = 0.29). |
| Study . | Design . | Patients . | Haemodynamic support . | Aetiologies . | Duration of follow-up . | Short-term outcome . | Long-term outcome . |
|---|---|---|---|---|---|---|---|
| Reddy 2014 | Prospective, multi-centre registry | 66 | IABP (n. 22), Impella 2.5 (n. 25), and Tandem Heart (n. 19) | 70% IHD, 30% NIDC | 12 ± 5 months | Compared to IABP, although with the use of Impella or Tandem Heart, more unstable VTs were mapped (1.05 vs. 0.32; P < 0.001) and a greater number of VTs was terminated (1.59 vs. 0.91; P = 0.007), periprocedural success and complications were similar. | Compared to IABP, Impella, and TandemHeart cohort had similar VT recurrence (42% vs. 50%) and mortality (36% in both). |
| Baratto 2016 | Retrospective, single-centre | 64 | ECMO (n. 64) | 45% IHD, 55% NIDC | 23 ± 13 months | No inducible VT achieved in 69%. In-hospital mortality was 1.5%. Major complications included acute kidney injury (6%), vascular injury (3%), and acute heart failure (8%). | At follow-up, VT recurred in 33%, overall mortality was 12%, and rate of transplantation was 9%. Transplant and LVAD-free survival was 69%. |
| Turagam 2017 | Retrospective, multicentre study (International VT Ablation Center Collaborative group) | 105 | Impella 2.5 ECMO Tandem Heart | 60% IHD, 40% NIDC | 527 days (208–1048) | Compared to 1550 undergoing VT ablation without HS, patients in the HS group were sicker, acute procedural success was lower and complications higher. | One-year mortality was significantly higher in the HS group. The use of HS was an independent predictor of mortality. However, in patients with LVEF <20% and NYHA functional Class III to IV, there was also no significant difference in clinical outcomes when compared with no HS. |
| Aryana 2017 | Retrospective analysis of US Medicare database | 345 | PVAD (not reported if Impella, ECMO or Tandem Heart) (n. 230), IABP (n. 115) | 60% IHD, 40% NIDCM | >12 months | Compared to IABP, PVAD was associated with reduced mortality (6.5% vs. 19.1%), cardiogenic shock (9.1% vs. 23.5%), acute kidney injury (11.7% vs. 21.7%), 30-day re-hospitalization (27.0% vs. 37.8%), and shorter hospital LOS (8.4 vs. 10.6 days). | PVAD group had similar re- do VT ablation rates at 1-year, compared with IABP (10.2% vs. 14.0%; P = 0.34). |
| Kusa 2017 | Retrospective, single-centre, PM | 194 | Impella 2.5 (n. 80), Impella CP (n. 29), control (n. 85)a | 57% IHD; 4% NIDCM | 7.17 months | In PM analysis, procedure duration was longer in Impella group but no significant difference in VT inducibility at procedure end (14% vs. 10%; P = 0.43) and complications (11% vs. 3%; P = 0.18) or hospital LOS. | No significant difference between Impella and control group in PM analysis for mortality (5% vs. 8%; P = 0.50), transplantation (5% vs. 0%; P = 0.25) or recurrent VT (26% vs. 21%; P = 0.29). |
ECMO, extracorporeal membrane oxygenation; HS, haemodynamic support; IABP, intra-aortic balloon pump; IHD, ischaemic heart disease; LOS, length of stay; LVAD, left ventricular assist device; LVEF, left ventricular ejection fraction; NIDC, •••; NIDCM, non-ischaemic dilated cardiomyopathy; NYHA, New York Heart Association; PM, propensity matched; PVAD, percutaneous ventricular assist device; VT, ventricular tachycardia.
Seventy-eight patients included in 1:1 propensity-matched analysis.
Summary of main studies reporting outcomes following use of mechanical circulatory support devices during ventricular tachycardia ablation
| Study . | Design . | Patients . | Haemodynamic support . | Aetiologies . | Duration of follow-up . | Short-term outcome . | Long-term outcome . |
|---|---|---|---|---|---|---|---|
| Reddy 2014 | Prospective, multi-centre registry | 66 | IABP (n. 22), Impella 2.5 (n. 25), and Tandem Heart (n. 19) | 70% IHD, 30% NIDC | 12 ± 5 months | Compared to IABP, although with the use of Impella or Tandem Heart, more unstable VTs were mapped (1.05 vs. 0.32; P < 0.001) and a greater number of VTs was terminated (1.59 vs. 0.91; P = 0.007), periprocedural success and complications were similar. | Compared to IABP, Impella, and TandemHeart cohort had similar VT recurrence (42% vs. 50%) and mortality (36% in both). |
| Baratto 2016 | Retrospective, single-centre | 64 | ECMO (n. 64) | 45% IHD, 55% NIDC | 23 ± 13 months | No inducible VT achieved in 69%. In-hospital mortality was 1.5%. Major complications included acute kidney injury (6%), vascular injury (3%), and acute heart failure (8%). | At follow-up, VT recurred in 33%, overall mortality was 12%, and rate of transplantation was 9%. Transplant and LVAD-free survival was 69%. |
| Turagam 2017 | Retrospective, multicentre study (International VT Ablation Center Collaborative group) | 105 | Impella 2.5 ECMO Tandem Heart | 60% IHD, 40% NIDC | 527 days (208–1048) | Compared to 1550 undergoing VT ablation without HS, patients in the HS group were sicker, acute procedural success was lower and complications higher. | One-year mortality was significantly higher in the HS group. The use of HS was an independent predictor of mortality. However, in patients with LVEF <20% and NYHA functional Class III to IV, there was also no significant difference in clinical outcomes when compared with no HS. |
| Aryana 2017 | Retrospective analysis of US Medicare database | 345 | PVAD (not reported if Impella, ECMO or Tandem Heart) (n. 230), IABP (n. 115) | 60% IHD, 40% NIDCM | >12 months | Compared to IABP, PVAD was associated with reduced mortality (6.5% vs. 19.1%), cardiogenic shock (9.1% vs. 23.5%), acute kidney injury (11.7% vs. 21.7%), 30-day re-hospitalization (27.0% vs. 37.8%), and shorter hospital LOS (8.4 vs. 10.6 days). | PVAD group had similar re- do VT ablation rates at 1-year, compared with IABP (10.2% vs. 14.0%; P = 0.34). |
| Kusa 2017 | Retrospective, single-centre, PM | 194 | Impella 2.5 (n. 80), Impella CP (n. 29), control (n. 85)a | 57% IHD; 4% NIDCM | 7.17 months | In PM analysis, procedure duration was longer in Impella group but no significant difference in VT inducibility at procedure end (14% vs. 10%; P = 0.43) and complications (11% vs. 3%; P = 0.18) or hospital LOS. | No significant difference between Impella and control group in PM analysis for mortality (5% vs. 8%; P = 0.50), transplantation (5% vs. 0%; P = 0.25) or recurrent VT (26% vs. 21%; P = 0.29). |
| Study . | Design . | Patients . | Haemodynamic support . | Aetiologies . | Duration of follow-up . | Short-term outcome . | Long-term outcome . |
|---|---|---|---|---|---|---|---|
| Reddy 2014 | Prospective, multi-centre registry | 66 | IABP (n. 22), Impella 2.5 (n. 25), and Tandem Heart (n. 19) | 70% IHD, 30% NIDC | 12 ± 5 months | Compared to IABP, although with the use of Impella or Tandem Heart, more unstable VTs were mapped (1.05 vs. 0.32; P < 0.001) and a greater number of VTs was terminated (1.59 vs. 0.91; P = 0.007), periprocedural success and complications were similar. | Compared to IABP, Impella, and TandemHeart cohort had similar VT recurrence (42% vs. 50%) and mortality (36% in both). |
| Baratto 2016 | Retrospective, single-centre | 64 | ECMO (n. 64) | 45% IHD, 55% NIDC | 23 ± 13 months | No inducible VT achieved in 69%. In-hospital mortality was 1.5%. Major complications included acute kidney injury (6%), vascular injury (3%), and acute heart failure (8%). | At follow-up, VT recurred in 33%, overall mortality was 12%, and rate of transplantation was 9%. Transplant and LVAD-free survival was 69%. |
| Turagam 2017 | Retrospective, multicentre study (International VT Ablation Center Collaborative group) | 105 | Impella 2.5 ECMO Tandem Heart | 60% IHD, 40% NIDC | 527 days (208–1048) | Compared to 1550 undergoing VT ablation without HS, patients in the HS group were sicker, acute procedural success was lower and complications higher. | One-year mortality was significantly higher in the HS group. The use of HS was an independent predictor of mortality. However, in patients with LVEF <20% and NYHA functional Class III to IV, there was also no significant difference in clinical outcomes when compared with no HS. |
| Aryana 2017 | Retrospective analysis of US Medicare database | 345 | PVAD (not reported if Impella, ECMO or Tandem Heart) (n. 230), IABP (n. 115) | 60% IHD, 40% NIDCM | >12 months | Compared to IABP, PVAD was associated with reduced mortality (6.5% vs. 19.1%), cardiogenic shock (9.1% vs. 23.5%), acute kidney injury (11.7% vs. 21.7%), 30-day re-hospitalization (27.0% vs. 37.8%), and shorter hospital LOS (8.4 vs. 10.6 days). | PVAD group had similar re- do VT ablation rates at 1-year, compared with IABP (10.2% vs. 14.0%; P = 0.34). |
| Kusa 2017 | Retrospective, single-centre, PM | 194 | Impella 2.5 (n. 80), Impella CP (n. 29), control (n. 85)a | 57% IHD; 4% NIDCM | 7.17 months | In PM analysis, procedure duration was longer in Impella group but no significant difference in VT inducibility at procedure end (14% vs. 10%; P = 0.43) and complications (11% vs. 3%; P = 0.18) or hospital LOS. | No significant difference between Impella and control group in PM analysis for mortality (5% vs. 8%; P = 0.50), transplantation (5% vs. 0%; P = 0.25) or recurrent VT (26% vs. 21%; P = 0.29). |
ECMO, extracorporeal membrane oxygenation; HS, haemodynamic support; IABP, intra-aortic balloon pump; IHD, ischaemic heart disease; LOS, length of stay; LVAD, left ventricular assist device; LVEF, left ventricular ejection fraction; NIDC, •••; NIDCM, non-ischaemic dilated cardiomyopathy; NYHA, New York Heart Association; PM, propensity matched; PVAD, percutaneous ventricular assist device; VT, ventricular tachycardia.
Seventy-eight patients included in 1:1 propensity-matched analysis.
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