Early de-cannulation from extracorporeal membrane oxygenation following ventricular tachycardia radiofrequency ablation
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 pro...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-10-01
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| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.998079/full |
| _version_ | 1798031161072549888 |
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| author | Avi Sabbag Avi Sabbag Johnatan Nissan Johnatan Nissan Roy Beinart Roy Beinart Leonid Sternik Leonid Sternik Igal Kassif Igal Kassif Alexander Kogan Alexander Kogan Eilon Ram Eilon Ram Eyal Nof Eyal Nof |
| author_facet | Avi Sabbag Avi Sabbag Johnatan Nissan Johnatan Nissan Roy Beinart Roy Beinart Leonid Sternik Leonid Sternik Igal Kassif Igal Kassif Alexander Kogan Alexander Kogan Eilon Ram Eilon Ram Eyal Nof Eyal Nof |
| author_sort | Avi Sabbag |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-04-11T19:53:02Z |
| format | Article |
| id | doaj.art-ccd75c6753d644c0924b39349c975cb1 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-11T19:53:02Z |
| publishDate | 2022-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-ccd75c6753d644c0924b39349c975cb12022-12-22T04:06:15ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-10-01910.3389/fcvm.2022.998079998079Early de-cannulation from extracorporeal membrane oxygenation following ventricular tachycardia radiofrequency ablationAvi Sabbag0Avi Sabbag1Johnatan Nissan2Johnatan Nissan3Roy Beinart4Roy Beinart5Leonid Sternik6Leonid Sternik7Igal Kassif8Igal Kassif9Alexander Kogan10Alexander Kogan11Eilon Ram12Eilon Ram13Eyal Nof14Eyal Nof15Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, IsraelDavidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, IsraelDavidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, IsraelDepartment of Cardiac Surgery, Sheba Medical Center, Ramat Gan, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, IsraelDepartment of Cardiac Surgery, Sheba Medical Center, Ramat Gan, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, IsraelDepartment of Cardiac Surgery, Sheba Medical Center, Ramat Gan, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, IsraelDepartment of Cardiac Surgery, Sheba Medical Center, Ramat Gan, IsraelDavidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, IsraelSackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, IsraelObjectivesVentricular 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.https://www.frontiersin.org/articles/10.3389/fcvm.2022.998079/fullvetricular tachycardiaextracorporeal membrane oxygenationablationcirculatory supportearly de-cannulation |
| spellingShingle | Avi Sabbag Avi Sabbag Johnatan Nissan Johnatan Nissan Roy Beinart Roy Beinart Leonid Sternik Leonid Sternik Igal Kassif Igal Kassif Alexander Kogan Alexander Kogan Eilon Ram Eilon Ram Eyal Nof Eyal Nof Early de-cannulation from extracorporeal membrane oxygenation following ventricular tachycardia radiofrequency ablation Frontiers in Cardiovascular Medicine vetricular tachycardia extracorporeal membrane oxygenation ablation circulatory support early de-cannulation |
| title | Early de-cannulation from extracorporeal membrane oxygenation following ventricular tachycardia radiofrequency ablation |
| title_full | Early de-cannulation from extracorporeal membrane oxygenation following ventricular tachycardia radiofrequency ablation |
| title_fullStr | Early de-cannulation from extracorporeal membrane oxygenation following ventricular tachycardia radiofrequency ablation |
| title_full_unstemmed | Early de-cannulation from extracorporeal membrane oxygenation following ventricular tachycardia radiofrequency ablation |
| title_short | Early de-cannulation from extracorporeal membrane oxygenation following ventricular tachycardia radiofrequency ablation |
| title_sort | early de cannulation from extracorporeal membrane oxygenation following ventricular tachycardia radiofrequency ablation |
| topic | vetricular tachycardia extracorporeal membrane oxygenation ablation circulatory support early de-cannulation |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.998079/full |
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