Abstract 21139: Ablation of Ventricular Arrhythmias in Patients with Decompensated Heart Failure and Electrical Storm is safe and efficacious.
Introduction: Patients with decompensated heart failure (NYHA IV HF) have been excluded from clinical research evaluating catheter ablation of ventricular arrhythmias (VT/VF) because of safety concerns. However, in some cases, VT/VF ablation is required urgently for incessant VT or electrical storm impeding optimization of volume status. We assessed the safety and efficacy of VT/VF ablation in patients with NYHA IV HF and electrical storm.
Methods: All patients referred for emergent VT/VF ablation to our institution in the setting of electrical storm (ES) or incessant VT and NYHA IV HF since 2006 were included in the cohort. NYHA IV HF was defined as dyspnea at rest or continuous inotropic support. ES was defined as 3 or more appropriates ICD shocks for VT/VF in 24 hours. We assessed the procedural success and complication rates and completed follow-up for all patients.
Results: There were 13 procedures performed emergently in 11 patients (9 males; mean age 59 +/− 6 years). All patients required endotracheal intubation for the procedure. Eight had ischemic and three had non-ischemic cardiomyopathy, with a mean LVEF of 23%. Five procedures were done in patients who required both mechanical and inotropic support and five were in those only requiring pharmacological support. Two of the patients failed an endocardial ablation attempt and required an epicardial approach. One case was aborted because high LVEDP (52 mmHg) and hypotension despite dopamine and epinephrine. This patient was the only one who developed a post-procedural complication (transient intranuclear ophtalmoplegia) due to a combination of hypotension and severe bilateral carotid stenosis. The mean number of VAs targeted, procedure duration and RFA performed was 25, 304 min and 54 respectively. All patients survived the hospitalization; one underwent heart transplantation for heart failure prior to discharge. There were no recurrences of ES after a median follow-up of 397 days.
Conclusions: Catheter Ablation of VT/VF in the setting of electrical storm and NYHA IV HF is safe and effective using an open irrigated tip catheter. We advocate elective endotracheal intubation, aggressive diuresis with inotropic support, and continuous hemodynamic monitoring during the ablation for optimal results.
- © 2010 by American Heart Association, Inc.