Impacts of Hemodynamic Support on Ventricular Arrhythmia Ablation

BACKGROUND: 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. OBJECTIVES: This study aimed to assess procedural efficacy, related complications, VA-free survival, and mortality of HF patients who underwent protected VA ablation with HS. METHODS: 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. RESULTS: 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). CONCLUSION: 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.