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Ventricular Tachycardia Radiofrequency Ablation with Extracorporeal Membrane Oxygenation

Avi Sabbag, Roy Beinart, Michael Eldar, Osnat Gurevitz, Amihay Shinfeld, Jacob Lavee, Ehud Raanani, Alexander Kogan, Dan Spiegelstein, Michael Glikson and Eyal Nof

Introduction: Cases of ventricular tachycardia (TV) with hemodynamic compromise present a challenge in achieving non-inducibility by radiofrequency catheter ablation (RFCA). We report our experience of VT RFCA facilitated by elective mechanical circulatory support.

Methods and results: Five patients with hemodynamically unstable, recurrent ventricular arrhythmias that were unresponsive to medical therapy underwent extracorporeal membrane oxygenation (ECMO) assisted RFCA of scar related VT. All underwent RFCA under general anesthesia and were connected to an ECMO circuit maintained at minimum flow of 1.5 L /min. In case of VT or VF the blood flow of the ECMO circuit was increased to 4 L/min to allow hemodynamic stability and adequate systemic organ perfusion. A total of 8 VTs were observed. In 4 cases, we mapped during VT the critical isthmus was found and ablated. Four VTs were targeted by substrate mapping only. Complete success, defined as non-inducibility with aggressive program stimulation of any VT, was achieved in 4 patients. In a single patient, a non-clinical VT was still inducible. He died of septic shock 24 hour after the procedure. The remaining 4 were free of ventricular arrhythmia as proven by implanted defibrillator interrogation, over a median follow up of 16 months.

Conclusion: ECMO implantation for VTRFCA is safe and assists in reaching the desired endpoint of noninducibility. This approach should be considered in high risk patients who may not otherwise tolerate such procedures.