Abstract 4362357: Elevated Right Atrial to Pulmonary Capillary Wedge Pressure Ratio Within 1 Year From Unplanned Ventricular Tachycardia Ablation Predicts Periprocedural Acute Kidney Injury and Hemodynamic Instability

Background: Risk stratification for patients undergoing urgent ventricular tachycardia (VT) ablation remains limited, especially regarding right heart dysfunction. We investigated whether the right atrial pressure (RAP) to pulmonary capillary wedge pressure (PCWP) ratio or pulmonary artery pulsatility index (PAPi) predicts in-hospital outcomes following urgent VT ablation. Methods: We retrospectively analyzed 102 consecutive patients who underwent unplanned (urgent or emergent) inpatient ventricular tachycardia (VT) ablation and had right heart catheterization (RHC) performed within the preceding 12 months. All patients were admitted with recurrent VT, of these 67 patients (66%) had VT storm. Patients were stratified by RAP: PCWP >0.6 versus ≤0.6 and PAPi <2 versus ≥2. Primary outcomes included post-procedural acute kidney injury (AKI, per kidney disease: Improving Global Outcomes [KDIGO] criteria) and intra-procedural hemodynamic instability. Multivariable logistic regression adjusted for age, sex, left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) class, ischemic cardiomyopathy, context of RHC (outpatient vs inpatient) and moderate-to-severe mitral and tricuspid regurgitation (MR, TR). Results: We analyzed 102 consecutive inpatients admitted for urgent inpatient VT ablation, all of whom had right heart catheterization within the prior year. The overall cohort was predominantly male (88%), with a mean age of 64 years, and a high burden of advanced heart failure, including LVEF <25% in 47% and NYHA class III–IV symptoms in 58% (Table 1). After multivariable adjustment, RAP: PCWP >0.6 independently predicted AKI (odds ratio [OR] 10.4, 95% confidence interval [CI] 2.4–14.1, p=0.002) and hemodynamic instability (OR 6.1, 95% CI 1.5–16.3, p=0.050). AKI was also significantly more frequent in patients over 60 (OR 12.8, 95% CI 1.3-21.3). Notably, LVEF<25% and NYHA III-IV were not significantly associated with these outcomes (Figure 1). Furthermore, PAPi <2 was not significantly associated with adverse outcomes. Conclusion: Among patients undergoing urgent inpatient VT ablation, an elevated RAP:PCWP ratio, but not PAPi, identifies individuals at heightened risk of AKI and intra-procedural hemodynamic instability. Incorporating RAP:PCWP into preprocedural assessment may improve risk stratification, perioperative planning, and patient selection.