Abstract 17161: pLVADs Are Superior to Pharmacological Agents Alone in Maintaining Cerebral Perfusion During Fast (Simulated) Ventricular Tachycardia
Background: The direct effects of percutaneous left ventricular assist devices (pLVAD) on maintaining end-organ perfusion during ventricular tachycardia (VT) ablation is unknown. We hypothesized that, as compared to pressors alone, a pLVAD would provide superior brain perfusion and oxygenation during VT.
Methods: Prospective study of 20 patients (mean age = 58.5 years, LVEF = 28%, and NYHA heart failure class = 2.5) undergoing ablation of scar-VT with an impeller-driven pLVAD (Impella 2.5). VT was simulated by RV pacing for 1 minute at 125, 150 or 200 bpm with the pLVAD at i) full-support (2.0 L/m), or ii) no-support (0.0 L/m). Cerebral oxygenation (SctO2) was continuously recorded with non-invasive cerebral oximetry. A SctO2 value ≤ 55% was considered the lower safety limit.
Results: The majority of patients had non-ischemic cardiomyopathy (n=13/20, 65%). As summarized in the Table, at 200 bpm, relative reductions in SctO2 were significantly greater with no-support ( -14.7%) as compared to pLVAD-support (-6.4%, p= <0.001). Furthermore, despite only 1 minute of pacing, cerebral dexoygenations down to the lower safety limits (SctO2 ≤ 55%) occurred significantly more often with no-support (n=7/20, 35%) as compared to with pLVAD-support (n=0/20, p= 0.008). The differences were not statistically significant at slower pacing rates.
Conclusions: In a cohort of 20 patients with severe left ventricular dysfunction and advanced heart failure class, pLVAD support was superior to pharamacolgical agents alone in maintaining cerebral oxygenation and perfusion during simulated fast VT. These findings lend support for the use of pLVADs in select patients with fast VT.
- © 2012 by American Heart Association, Inc.