Percutaneous ventricular assist device in ventricular tachycardia ablation: a systematic review and meta-analysis

Mohit K. Turagam, Venkat Vuddanda, Scott Koerber, Jalaj Garg, Bharath Yarlagadda, Tawseef Dar, Arash Aryana, Luigi Di Biase, Andrea Natale, Dhanunjaya Lakkireddy

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: There is a lack of compelling data regarding the benefit of percutaneous ventricular assist devices (PVAD) in patients undergoing ventricular tachycardia (VT) ablation. The study aims to conduct a meta-analysis comparing the safety and efficacy of PVAD versus no-PVAD (N-PVAD) during VT ablation. Methods: Studies meeting criteria were systematically reviewed. Baseline characteristics and clinical outcomes were extracted and analyzed. A meta-analysis was performed using random-effects model to calculate risk ratio (RR) and mean difference (MD) with 95% confidence interval (CI). Results: The meta-analysis included five retrospective, observational studies consisting of 2026 patients (PVAD group—284 patients versus N-PVAD group—1742 patients). The PVAD group was sicker with significantly higher VT storm, lower LVEF and greater proportion of NYHA class ≥ III than N-PVAD (p < 0.050). The acute procedural success [RR 0.95, 95% CI, (0.89–1.00), p = 0.070], VT recurrence [RR 0.94, 95% CI, (0.66–1.34), p = 0.740] and mortality [RR 1.28, 95% CI, (0.43–3.83), p = 0.660] were similar on follow-up between PVAD versus N-PVAD. PVAD group also had significantly higher complications [RR 1.83, 95% CI (1.21–2.76), p = 0.004] and longer fluoroscopy [MD + 7.31 min, 95% CI (0.91–13.71), p = 0.030] and procedure time [MD + 71.41 min, 95% CI (31.67–111.14), p < 0.001] than N-PVAD. Conclusion: Patients receiving PVAD support during VT ablation were sicker with no significant difference in acute procedural success, VT recurrence, and mortality compared with N-PVAD. PVAD support was also associated with higher complications and longer fluoroscopy and procedure time. A prospective randomized controlled trial will identify if using PVAD support in unstable patients undergoing VT ablation will impact clinical outcomes.

Original languageEnglish (US)
JournalJournal of Interventional Cardiac Electrophysiology
DOIs
StateAccepted/In press - Jan 1 2018

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Heart-Assist Devices
Ventricular Tachycardia
Meta-Analysis
Confidence Intervals
Odds Ratio
Fluoroscopy
Recurrence
Mortality
Observational Studies
Randomized Controlled Trials
Retrospective Studies
Safety

Keywords

  • Catheter ablation
  • ECMO
  • Hemodynamic support
  • Impella
  • Percutaneous ventricular assist device
  • Tandem heart
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Percutaneous ventricular assist device in ventricular tachycardia ablation : a systematic review and meta-analysis. / Turagam, Mohit K.; Vuddanda, Venkat; Koerber, Scott; Garg, Jalaj; Yarlagadda, Bharath; Dar, Tawseef; Aryana, Arash; Di Biase, Luigi; Natale, Andrea; Lakkireddy, Dhanunjaya.

In: Journal of Interventional Cardiac Electrophysiology, 01.01.2018.

Research output: Contribution to journalArticle

Turagam, Mohit K. ; Vuddanda, Venkat ; Koerber, Scott ; Garg, Jalaj ; Yarlagadda, Bharath ; Dar, Tawseef ; Aryana, Arash ; Di Biase, Luigi ; Natale, Andrea ; Lakkireddy, Dhanunjaya. / Percutaneous ventricular assist device in ventricular tachycardia ablation : a systematic review and meta-analysis. In: Journal of Interventional Cardiac Electrophysiology. 2018.
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abstract = "Background: There is a lack of compelling data regarding the benefit of percutaneous ventricular assist devices (PVAD) in patients undergoing ventricular tachycardia (VT) ablation. The study aims to conduct a meta-analysis comparing the safety and efficacy of PVAD versus no-PVAD (N-PVAD) during VT ablation. Methods: Studies meeting criteria were systematically reviewed. Baseline characteristics and clinical outcomes were extracted and analyzed. A meta-analysis was performed using random-effects model to calculate risk ratio (RR) and mean difference (MD) with 95{\%} confidence interval (CI). Results: The meta-analysis included five retrospective, observational studies consisting of 2026 patients (PVAD group—284 patients versus N-PVAD group—1742 patients). The PVAD group was sicker with significantly higher VT storm, lower LVEF and greater proportion of NYHA class ≥ III than N-PVAD (p < 0.050). The acute procedural success [RR 0.95, 95{\%} CI, (0.89–1.00), p = 0.070], VT recurrence [RR 0.94, 95{\%} CI, (0.66–1.34), p = 0.740] and mortality [RR 1.28, 95{\%} CI, (0.43–3.83), p = 0.660] were similar on follow-up between PVAD versus N-PVAD. PVAD group also had significantly higher complications [RR 1.83, 95{\%} CI (1.21–2.76), p = 0.004] and longer fluoroscopy [MD + 7.31 min, 95{\%} CI (0.91–13.71), p = 0.030] and procedure time [MD + 71.41 min, 95{\%} CI (31.67–111.14), p < 0.001] than N-PVAD. Conclusion: Patients receiving PVAD support during VT ablation were sicker with no significant difference in acute procedural success, VT recurrence, and mortality compared with N-PVAD. PVAD support was also associated with higher complications and longer fluoroscopy and procedure time. A prospective randomized controlled trial will identify if using PVAD support in unstable patients undergoing VT ablation will impact clinical outcomes.",
keywords = "Catheter ablation, ECMO, Hemodynamic support, Impella, Percutaneous ventricular assist device, Tandem heart, Ventricular tachycardia",
author = "Turagam, {Mohit K.} and Venkat Vuddanda and Scott Koerber and Jalaj Garg and Bharath Yarlagadda and Tawseef Dar and Arash Aryana and {Di Biase}, Luigi and Andrea Natale and Dhanunjaya Lakkireddy",
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T1 - Percutaneous ventricular assist device in ventricular tachycardia ablation

T2 - a systematic review and meta-analysis

AU - Turagam, Mohit K.

AU - Vuddanda, Venkat

AU - Koerber, Scott

AU - Garg, Jalaj

AU - Yarlagadda, Bharath

AU - Dar, Tawseef

AU - Aryana, Arash

AU - Di Biase, Luigi

AU - Natale, Andrea

AU - Lakkireddy, Dhanunjaya

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: There is a lack of compelling data regarding the benefit of percutaneous ventricular assist devices (PVAD) in patients undergoing ventricular tachycardia (VT) ablation. The study aims to conduct a meta-analysis comparing the safety and efficacy of PVAD versus no-PVAD (N-PVAD) during VT ablation. Methods: Studies meeting criteria were systematically reviewed. Baseline characteristics and clinical outcomes were extracted and analyzed. A meta-analysis was performed using random-effects model to calculate risk ratio (RR) and mean difference (MD) with 95% confidence interval (CI). Results: The meta-analysis included five retrospective, observational studies consisting of 2026 patients (PVAD group—284 patients versus N-PVAD group—1742 patients). The PVAD group was sicker with significantly higher VT storm, lower LVEF and greater proportion of NYHA class ≥ III than N-PVAD (p < 0.050). The acute procedural success [RR 0.95, 95% CI, (0.89–1.00), p = 0.070], VT recurrence [RR 0.94, 95% CI, (0.66–1.34), p = 0.740] and mortality [RR 1.28, 95% CI, (0.43–3.83), p = 0.660] were similar on follow-up between PVAD versus N-PVAD. PVAD group also had significantly higher complications [RR 1.83, 95% CI (1.21–2.76), p = 0.004] and longer fluoroscopy [MD + 7.31 min, 95% CI (0.91–13.71), p = 0.030] and procedure time [MD + 71.41 min, 95% CI (31.67–111.14), p < 0.001] than N-PVAD. Conclusion: Patients receiving PVAD support during VT ablation were sicker with no significant difference in acute procedural success, VT recurrence, and mortality compared with N-PVAD. PVAD support was also associated with higher complications and longer fluoroscopy and procedure time. A prospective randomized controlled trial will identify if using PVAD support in unstable patients undergoing VT ablation will impact clinical outcomes.

AB - Background: There is a lack of compelling data regarding the benefit of percutaneous ventricular assist devices (PVAD) in patients undergoing ventricular tachycardia (VT) ablation. The study aims to conduct a meta-analysis comparing the safety and efficacy of PVAD versus no-PVAD (N-PVAD) during VT ablation. Methods: Studies meeting criteria were systematically reviewed. Baseline characteristics and clinical outcomes were extracted and analyzed. A meta-analysis was performed using random-effects model to calculate risk ratio (RR) and mean difference (MD) with 95% confidence interval (CI). Results: The meta-analysis included five retrospective, observational studies consisting of 2026 patients (PVAD group—284 patients versus N-PVAD group—1742 patients). The PVAD group was sicker with significantly higher VT storm, lower LVEF and greater proportion of NYHA class ≥ III than N-PVAD (p < 0.050). The acute procedural success [RR 0.95, 95% CI, (0.89–1.00), p = 0.070], VT recurrence [RR 0.94, 95% CI, (0.66–1.34), p = 0.740] and mortality [RR 1.28, 95% CI, (0.43–3.83), p = 0.660] were similar on follow-up between PVAD versus N-PVAD. PVAD group also had significantly higher complications [RR 1.83, 95% CI (1.21–2.76), p = 0.004] and longer fluoroscopy [MD + 7.31 min, 95% CI (0.91–13.71), p = 0.030] and procedure time [MD + 71.41 min, 95% CI (31.67–111.14), p < 0.001] than N-PVAD. Conclusion: Patients receiving PVAD support during VT ablation were sicker with no significant difference in acute procedural success, VT recurrence, and mortality compared with N-PVAD. PVAD support was also associated with higher complications and longer fluoroscopy and procedure time. A prospective randomized controlled trial will identify if using PVAD support in unstable patients undergoing VT ablation will impact clinical outcomes.

KW - Catheter ablation

KW - ECMO

KW - Hemodynamic support

KW - Impella

KW - Percutaneous ventricular assist device

KW - Tandem heart

KW - Ventricular tachycardia

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