Invasive Assessment of Right Ventricular Dysfunction Predicts Periprocedural Outcomes in Patients Undergoing...

Risk stratification in patients undergoing urgent ventricular tachycardia (VT) ablation is limited, particularly regarding right ventricular dysfunction, which is often underrecognized in this setting.

We investigated whether the right atrial pressure (RAP) to pulmonary capillary wedge pressure (PCWP) ratio or pulmonary artery pulsatility index (PAPi) predicts short-term outcomes following urgent VT ablation.

We retrospectively analyzed 102 consecutive patients who underwent unplanned inpatient VT ablation and had right heart catheterization (RHC) within the preceding 12 months. All were admitted with recurrent VT; 67 (66%) had VT storm. Hemodynamic stratification was performed using two established indices of right-sided function: RAP:PCWP > 0.6 versus ≤ 0.6 and pulmonary artery pulsatility index (PAPi) < 2 versus ≥ 2, calculated as (pulmonary artery systolic pressure - pulmonary artery diastolic pressure)/right atrial pressure. Outcomes included acute kidney injury (AKI), intraprocedural hemodynamic instability, 30-day VT recurrence, 30-day mortality/LVAD/transplant, delayed extubation, postoperative length of stay > 7 days, and same-day complications. Multivariable logistic regression adjusted for age, sex, LVEF, NYHA class, ischemic cardiomyopathy, RHC type, and moderate-to-severe MR/TR.

The cohort was 88% male, mean age 64 ± 11.9 years; 47% had LVEF < 25%, and 58% NYHA III-IV symptoms. RAP:PCWP > 0.6 was independently associated with higher risk of AKI (OR 10.4, 95% CI 2.4-14.1, p = 0.002) and intraprocedural hemodynamic instability (OR 6.1, 95% CI 1.5-16.3, p = 0.050). Age > 60 also predicted AKI (OR 12.8, 95% CI 1.3-21.3). PAPi < 2 and LVEF < 25% were not associated with adverse outcomes.

Among urgent VT ablation patients, elevated RAP:PCWP, but not PAPi, identifies those at increased risk for AKI and intraprocedural hemodynamic instability. Incorporating RAP:PCWP into preprocedural assessment may enhance risk stratification.