Iwanari Kawamura, Jacob S Koruth, Shigeki Kusa, Jin Iwasawa, Jeff Lam, Betsy Ellsworth, Keita Watanabe, Moritz Nies, Joshua Lampert, Abhishek Maan, Daniel R Musikantow, Mohit K Turagam, Noah Moss, William Whang, Marc A Miller, Vivek Y Reddy, Srinivas Dukkipati
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引用次数: 0
Abstract
Background: Percutaneous left ventricular assist devices (pLVADs) are often used in critically ill patients undergoing scar-related ventricular tachycardia (VT) ablation. However, there are no randomized controlled trials evaluating their benefits.
Objectives: The goal of this study was to compare outcomes between pLVAD- and non-pLVAD-supported VT ablation using a propensity score matching analysis.
Methods: This retrospective analysis comprised 481 scar-related VT patients who underwent catheter ablation (175 pLVAD and 306 non-pLVAD). A 1:1 propensity score matching was conducted to balance baseline characteristics for comparison of procedural and long-term outcomes.
Results: A propensity score analysis generated 115 matched pairs in each group. Baseline characteristics of the matched cohorts were comparable (mean left ventricular ejection fraction 27%, 40% NYHA functional class ≥III, and 36% electrical storm). Compared with the non-pLVAD, more patients in the pLVAD group had at least 1 VT termination during ablation. Despite including a higher use of advanced ablation strategies and a longer procedure time, the pLVAD group had a postprocedural VT inducibility similar to that of the non-pLVAD group. The incidence of periprocedural major complications was higher among pLVAD patients (29.6% vs 13.9%; P = 0.004), largely driven by vascular complications requiring intervention and periprocedural heart failure. During a median follow-up of 326 days, Kaplan-Meier curves showed no statistically significant differences in composite outcome (hospitalization for VT or worsening heart failure requiring hospitalization, LVAD implantation, orthotopic heart transplantation, and all-cause mortality), and VT recurrence.
Conclusions: The use of pLVADs during VT ablation is associated with longer procedures and higher procedural complications without any benefit in acute or long-term outcomes.
背景：经皮左心室辅助装置（pLVADs）常用于接受瘢痕相关性室性心动过速（VT）消融的危重患者。然而，没有随机对照试验评估它们的益处。目的：本研究的目的是通过倾向评分匹配分析比较pLVAD支持和非pLVAD支持的VT消融的结果。方法：回顾性分析481例接受导管消融的疤痕相关VT患者（175例pLVAD， 306例非pLVAD）。进行1:1倾向评分匹配，以平衡基线特征，以比较程序和长期结果。结果：倾向评分分析在每组中产生115对匹配的配对。匹配队列的基线特征具有可比性（平均左室射血分数27%，NYHA功能等级≥III级40%，电风暴36%）。与非pLVAD组相比，pLVAD组患者在消融过程中至少有1次VT终止。尽管采用了更高的先进消融策略和更长的手术时间，但pLVAD组的术后VT诱导率与非pLVAD组相似。pLVAD患者术中重大并发症发生率较高（29.6% vs 13.9%; P = 0.004），主要是由于血管并发症需要干预和术中心力衰竭所致。在中位随访326天期间，Kaplan-Meier曲线显示复合结局（因室性心动过速住院或恶化的心衰需要住院、LVAD植入、原位心脏移植和全因死亡率）和室性心动过速复发无统计学差异。结论：在VT消融期间使用pLVADs与较长的手术过程和较高的手术并发症相关，对急性或长期结果没有任何益处。
期刊介绍：
JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.
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