Project description:ObjectivesVentricular 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 methodsAll 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.ResultsA 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.ConclusionDe-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.

| S-EPMC9622793 | biostudies-literature

Ablation index-guided catheter ablation of incessant ventricular tachycardia originating from the anterolateral papillary muscle.

Project description: Not available

| S-EPMC9054870 | biostudies-literature

Successful ablation of ventricular tachycardia arising from a midmyocardial septal outflow tract site utilizing a simplified bipolar ablation setup.

Project description: Not available

| S-EPMC6379518 | biostudies-literature

Successful catheter ablation of intraseptal ventricular tachycardia from the entrance side of the slow conduction zone.

Project description: Not available

| S-EPMC10444554 | biostudies-literature

Provisional Circulatory Support with Extracorporeal Membrane Oxygenation during Ventricular Tachycardia Ablation in Intermediate Risk Patients: A Case Series.

Project description:Background: Cardiogenic shock with acute hemodynamic decompensation may be one of the most serious risks in patients affected by ventricular tachycardia (VT). Its proper identification may have important implications in terms of pharmacological management, as might procedural planning in case of patients undergoing catheter ablation. Methods: We describe a case series of patients with provisional strategies for circulatory support in VT ablation, including the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) and vascular accesses in the electrophysiology lab but no initial ECMO activation due to an estimated intermediate pre-procedural risk from the case-series population. Results: In total, 10 patients (mean age 70 ± 11 years old, 9 males) with severe cardiomyopathy were admitted for incessant ventricular arrhythmia episodes, further diagnosis, and therapy planning; 1/10 patients (10%), documenting a PAINESD score of 14, underwent VA-ECMO cannulation due to electromechanical dissociation. All 10 patients were discharged alive. Conclusions: A pre-defined strategy before VT ablation is crucial. In our case series, the use of provisional circulatory support with VA-ECMO during incessant ablation of ventricular arrhythmia was a safe and winning alternative to upfront strategies.

| S-EPMC11312705 | biostudies-literature

Radiofrequency ablation of deep seated outflow tract ventricular tachycardia using custom modified bipolar irrigated radiofrequency ablation setup.

Project description: Not available

| S-EPMC6823727 | biostudies-literature

Incessant non-sustained ventricular tachycardia immediately after MitraClip placement: a case report.

Project description:BackgroundMitraClip therapy has become an alternative therapy for primary and secondary mitral regurgitation (MR) in patients at high surgical risk. However, this procedure is associated with several complications.Case summaryThe patient was a 93-year-old male with severe MR caused by prolapse of the mid-posterior mitral leaflet (P2) and atrial enlargement. His heart failure (HF) continued to worsen, requiring hospitalization. Considering his high surgical risk, the heart team chose MitraClip treatment. After one clip was placed in the centre of the mitral valve (P2 lateral side), MR severity was reduced from severe to trivial. However, immediately after grasping, incessant non-sustained ventricular tachycardia (VT) with a heart rate of 150 beats/min occurred. Since there were no significant ST-T changes on electrocardiogram and no left ventricular (LV) wall motion abnormalities on echocardiography, ischaemic heart disease was ruled out, and pacing with a temporary pacemaker, potassium level correction, and intravenous amiodarone administration were performed. The frequency of VT decreased but it did not disappear. Diuretics were administered for HF, and VT disappeared within a few hours, with no recurrence, probably due to a decrease in the LV chamber size after diuresis.DiscussionThe VT waveform showed a right bundle branch block pattern with a superior axis. Furthermore, a negative lead I and a transition zone with an abrupt change from V4 to V5 indicated that PVC/VT arose from the posterior papillary muscle area. The probable cause was mechanical extension of the posterior medial papillary muscle as a result of leaflet grasping, with resolution following appropriate volume management.

| S-EPMC9547541 | biostudies-literature

Adenosine-sensitive incessant right ventricular outflow tract ventricular tachycardia complicating fulminant lymphocytic myocarditis: Case report.

Project description: Not available

| S-EPMC10801133 | biostudies-literature

High‐density mapping and ablation of an incessant ventricular tachycardia with endo‐epicardial involvement in a patient with situs inversus totalis and left ventricular noncompaction

Project description:The association of situs inversus totalis and left ventricular noncompaction is very rare and poses several and unique challenges if endo‐epicardial ablation has to be performed, both for anatomical access to the target area and for arrhythmia complexity. We report a case of incessant ventricular tachycardia with endo‐epicardial involvement that required ablation in both surfaces to obtain final noninducibility

| S-EPMC8022008 | biostudies-literature

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