Impacts of Hemodynamic Support on Ventricular Arrhythmia Ablation

Data on the efficacy of hemodynamic support (HS) for protecting ventricular arrhythmia (VA) ablation in high-risk heart failure (HF) patients with an impaired left ventricular function and its impact on mortality is limited.

This study aimed to assess procedural efficacy, related complications, VA-free survival, and mortality of HF patients who underwent protected VA ablation with HS.

Data from consecutive HF patients undergoing VA ablation at our center between 2018 and 2024 were analyzed. HS included the treatment with an Impella, an extracorporeal membrane oxygenation (ECMO) or a left ventricular assist device (LVAD). Patients were classified based on their HF status according to current guidelines.

A total of 187 patients (61.5 ± 10.9 years) were included. 124/187 patients were in advanced HF (66%, 63.5 ± 8.9 years). In 68/187 patients (36%, 60.8 ± 9.8 years), HS was required. Procedural parameter did not differ between the groups except for fluoroscopy times (p < 0.001). Acute procedural success (p = 0.670) and major procedure-related complications (p = 0.726) were comparable. In-hospital mortality was higher in patients with HS (p < 0.001). In advanced HF patients, freedom from VA-recurrence was lower (p = 0.016) and mortality higher (p = 0.009). HS with an ECMO and LVAD, but not with an Impella, was associated with increased VA-recurrence (hazard ratio [HR] 3.66, confidence Interval [CI] 1.732-7.715, p < 0.001) and mortality (HR 3.95, CI 1.091-14.280, p = 0.036).

In high-risk HF patients, VA ablation was feasible with comparable acute success and procedural complication rates. Patients with ECMO or LVAD showed higher in-hospital mortality and higher VA recurrence compared to Impella-supported procedures, likely reflecting more advanced disease severity rather than differences in procedural efficacy.