Association of mechanical circulatory support use with inpatient outcomes in patients undergoing ventricular tachycardia ablation.

Abstract

Background: Ventricular tachycardia (VT) ablation is a high-risk procedure that often requires induction of VT for activation and entrainment mapping. VT induction, particularly those with rapid cycle lengths tends to predispose patients to acute hemodynamic instability, sometimes necessitating mechanical circulatory support (MCS) to maintain perfusion, especially during longer procedures.

Purpose: We sought to evaluate clinical and procedural outcomes in patients requiring MCS during VT ablation.

Methods: We queried the 2017-2021 National Inpatient Sample (NIS) database and identified patients who underwent VT ablation using ICD-10 codes. Patients were stratified based on the use of MCS during VT ablation. MCS devices included intra-aortic balloon pump (IABP), percutaneous ventricular assist device (pVAD), and extracorporeal membrane oxygenation (ECMO). We then compared clinical outcomes and utilization of resources between the two groups (VT ablation with MCS vs. VT ablation without MCS).

Results: A total of 10,980 patients underwent VT ablations during the specified time period of 2017-2021 and of these, 815 (7.42%) required MCS during the ablation procedure. The patients who required MCS had a significantly higher in-hospital mortality as compared to those who did not require MCS (16.56% vs. 2.26%, p < 0.001). The use of MCS was also associated with a relatively longer length of inpatient stay (mean: 18 vs. 6 days, p = 0.01) and also incurred a greater cost of hospitalization (USD 538,598 vs. 200,308, p < 0.001). The risk of inpatient complications (such as acute kidney injury, stroke, cardiac tamponade, bleeding and vascular complications) was also observed to be higher in the group of patients requiring MCS vs. the group which did not require MCS during VT ablation.

Conclusions: The utilization of MCS during VT ablation was associated with significantly worse inpatient outcomes, post-procedural complications and a longer stay in the hospital. It is plausible that patients requiring MCS during VT ablation represent a relatively sicker subset of patients. Despite the use of MCS to prevent hemodynamic compromise during VT ablation, the post-procedural outcomes remain poorer. Our findings also suggest that an individualized strategy for the use of MCS might be more useful than an empiric use of MCS during VT ablation.