Abstract 4139507: Impact of Hemodynamic Management on Early Mortality in Patients Undergoing Radiofrequency Catheter Ablation for Ventricular Tachycardia: A Single Center Experience

Background: Catheter ablation (CA) is an established treatment for ventricular arrhythmias (VAs). Vasoactive drugs are used to manage intraprocedural acute hemodynamic decompensation (AHD). To date, there is limited data on the association between intra-procedural vasoactive drug choice and outcomes in patients undergoing VA CA. Objective: Evaluate if the use of certain vasoactive agents interprocedurally is associated with worse outcomes in patients undergoing VA CA. Methods: This was a single center retrospective analysis of patients undergoing VA CA 2018-2023. Patients were risk-stratified using the PAAINESD score (calculated by: presence of lung disease, age >60, anesthesia use, New York Heart Association classification III/IV, left ventricular ejection fraction (LVEF) <25%, electrical storm, and diabetes mellitus) and divided into low- (<10), medium- (10-16), and high-risk (>16) tertiles. Use of vasoactive drugs between tertiles was compared, as were outcomes when pure afterload agents (-INO), versus agents with positive inotropy (+INO) were used. Results: Two hundred and three patients undergoing 233 procedures were included. Mean (±SD) age was 62±13years, LVEF was 37±15%; 1/3 had LVEF<25%, and 99 (39%) were NYHA III/IV. Median (range) PAAINESD was 17 (5-36). Use of -INO (ephedrine, phenylephrine, or vasopressin) occurred in 179 patients (77%); 63(27%) received 2 -INO, and 10 (4%) received 3 -INO agents. Twelve (5%) died within 90 days, all with PAAINESD >16, and all with 1 -INO used interprocedurally (Fig., A). After adjustment for LVEF and +INO, increasing number of -INO was significantly associated with 90-day mortality (OR 2.67, 95%CI 1.24 – 5.76, P=0.012; Fig., B), as was the cumulative dose of -INO (OR 1.43, 95%CI 1.03 – 1.98, P=0.031, Fig., C). Discussion: Among patients with depressed LV function undergoing VAs ablation, the use of pure afterload agents is associated with increased 90-day mortality, especially among patients with high baseline risk of AHD.