Early de-cannulation from extracorporeal membrane oxygenation following ventricular tachycardia radiofrequency ablation

• Published in: Frontiers in cardiovascular medicine Vol. 9; p. 998079
• Main Authors: Sabbag, Avi, Nissan, Johnatan, Beinart, Roy, Sternik, Leonid, Kassif, Igal, Kogan, Alexander, Ram, Eilon, Nof, Eyal
• Format: Journal Article
• Language: English
• Published: Frontiers Media S.A 18.10.2022
• Subjects: ablation; Cardiovascular Medicine; circulatory support; early de-cannulation; extracorporeal membrane oxygenation; vetricular tachycardia
• ISSN: 2297-055X; 2297-055X
• DOI: 10.3389/fcvm.2022.998079

Objectives Ventricular tachycardia ablation (VTA) with hemodynamic compromise presents a challenge. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support allows the safe completion of the procedure. There are limited data regarding the safety of weaning off VA-ECMO at the end of the procedure. We report our experience with early VA-ECMO de-cannulation after VTA. Materials and methods All patients undergoing VA-ECMO-assisted VTA, between January 2013 and December 2020 at a large tertiary center were included. Clinical characteristics, history of arrhythmia, procedural details, and outcomes were collected. Patients weaned from VA-ECMO immediately at the end of the procedure were compared to those that were de-cannulated at a later time. Results A total of 46 patients (93.5% male, age 62 ± 10 years) were ablated with VA-ECMO support. Most had ischemic cardiomyopathy (65%) and (70%) presented with VT storm. The clinical VT was induced in the majority of patients (76%). A total of 99 VTs were induced of which 76 (77%) were targeted and successfully ablated. Non-inducibility was achieved in 74% of cases and most patients (83%) were de-cannulated at the end of the procedure on the procedure table. Survival at 1 year was higher among early de-cannulated patients (86 vs. 38% [log-rank p -value < 0.001]). At 1-year follow-up, 91.3% of surviving patients were free of appropriate ICD shocks. Conclusion De-cannulation from VA-ECMO may be done immediately at the conclusion of VTA in most cases. Failure to timely wean off VA-ECMO is a strong predictor of mortality.