Outcomes with prophylactic use of percutaneous left ventricular assist devices in high-risk patients undergoing catheter ablation of scar-related ventricular tachycardia: A propensity-score matched analysis

摘要

BackgroundThe PAINESD score predicts the risk of periprocedural acute hemodynamic decompensation (AHD) and postprocedural mortality in patients undergoing catheter ablation (CA) of scar-related ventricular tachycardia (VT). The role of prophylactic placement of percutaneous left ventricular assist devices (pLVADs) in high-risk patients is unknown. ObjectiveThe purpose of this study was to evaluate the outcomes of prophylactic use of pLVAD in high-risk patients undergoing CA of scar-related VT. MethodsWe included 75 patients undergoing CA of scar-related VT in whom a prophylactic pLVAD was implanted because of perceived high risk. The control population was a propensity-matched group of 75 patients who did not undergo prophylactic pLVAD placement. The PAINESD score was used for propensity matching. ResultsThe median PAINESD score was 13 (41% with score ≥15) in the prophylactic pLVAD group and 12 (40% with score ≥15) in the control group. Periprocedural AHD occurred in 5 patients (7%) in the prophylactic pLVAD group and in 17 patients (23%) in the control group (P< .01). The 12-month cumulative incidence of VT was 40% in the prophylactic pLVAD group vs 41% in the control group (P= .97), while the 12-month incidence of death/transplant was 33% vs 66%, respectively (P< .01). In multivariable analysis, left ventricular ejection fraction (HR 0.97, 95% CI 0.95–0.99,P= .03), chronic kidney disease (HR 2.24, 95% CI 1.35–3.72,P< .01), VT recurrence (HR 2.33, 95% CI 1.31–4.14,P< .01), and prophylactic pLVAD (HR 0.28, 95% CI 0.16–0.49,P?< .01) were all independently associated with death/transplant. ConclusionProphylactic pLVAD placement in high-risk patients undergoing CA of scar-related VT is associated with a reduced risk of AHD and death/transplant during follow-up without affecting VT-free survival.