About this Research Topic
Life-threatening refractory unstable ventricular arrhythmias (VA) in presence of advanced heart failure may determine hemodynamic impairment. Mechanical circulatory support (MCS) has a relevant role to restore organ perfusion. Catheter ablation of VA is effective at achieving rhythm stabilization and improving prognosis; however, patients with hemodynamically unstable VA have a higher rate of procedural complications and mortality. Acute heart decompensation during catheter ablation of complex substrates may occur in 11% of cases and is associated with an increased risk of mortality. Recent data suggests that MCS can provide valuable support during catheter ablation procedures to prevent periprocedural adverse outcomes
Multiple devices are available for MCS in patients with hemodynamically unstable VA (Intra-aortic balloon pump; Tandem heart; Impella and Extracorporeal membrane oxygenation). The choice of the system depends on different factors: the patient’s hemodynamic condition, acquaintance with devices and the goal of the mechanical support. Large randomized clinical trials comparing different devices for MCS and different ablation strategies in the setting of hemodynamically unstable VA are not available. Furthermore, prospective multicentre data are missing also about patient risk stratification to use a prophylactic MCS before catheter ablation. It is essential to report the experiences of all high-volume Centers for the use of MCS during catheter ablation of hemodynamically unstable VA to define the optimal strategy aimed to improve the prognosis of these patients.
This Research Topic will propose and discuss current management strategies for MCS during ablation of hemodynamically unstable VA. In particular, this Research Topic will discuss the advantages and disadvantages of each device for MCS, the procedural management of all devices for MCS, the ablative strategy during MCS (substrate-based vs. ventricular tachycardia-based ablation strategy), the selection of patients candidate for the preventive use of MCS before catheter ablation and, finally, the role of ventricular inducibility at the end of the procedure.
Multiple devices are available for MCS in patients with hemodynamically unstable VA (Intra-aortic balloon pump; Tandem heart; Impella and Extracorporeal membrane oxygenation). The choice of the system depends on different factors: the patient’s hemodynamic condition, acquaintance with devices and the goal of the mechanical support. Large randomized clinical trials comparing different devices for MCS and different ablation strategies in the setting of hemodynamically unstable VA are not available. Furthermore, prospective multicentre data are missing also about patient risk stratification to use a prophylactic MCS before catheter ablation. It is essential to report the experiences of all high-volume Centers for the use of MCS during catheter ablation of hemodynamically unstable VA to define the optimal strategy aimed to improve the prognosis of these patients.
This Research Topic will propose and discuss current management strategies for MCS during ablation of hemodynamically unstable VA. In particular, this Research Topic will discuss the advantages and disadvantages of each device for MCS, the procedural management of all devices for MCS, the ablative strategy during MCS (substrate-based vs. ventricular tachycardia-based ablation strategy), the selection of patients candidate for the preventive use of MCS before catheter ablation and, finally, the role of ventricular inducibility at the end of the procedure.
Keywords: Cardiopulmonary Support, Catheter Ablation, Ventricular Arrhythmias, Hemodynamic Instability
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