Extracorporeal Membrane Oxygenation (ECMO) for Hemodynamic Support during Ventricular Tachycardia Ablation: Sheba Medical Center Experience - The 65th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 24-25 April 2018

Alexander Kogan Elchanan Zuroff Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel Eyal Nof Institute of Cardiology, Sheba Medical Center, Ramat Gan, Israel Yigal Kassif Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel Roy Beinert Institute of Cardiology, Sheba Medical Center, Ramat Gan, Israel Yaron Schwartz Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel Jacob Lavee Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel Ehud Raanani Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel

Introduction:

Utilization of extracorporeal membrane oxygenation (ECMO) is expanding in the last years. In patients with ventricular tachycardia or ventricular fibrillation (VT/VF) electrical storm (ES) undergoing catheter ablation (CA), hypotension due to refractory VT/VF, use of anesthesia, and cardiac stunning due to repeated implantable cardioverter-defibrillator shocks might precipitate acute hemodynamic decompensation. We report our experience in an ECMO-assisted hemodynamic support during ventricular tachycardia ablation in our hospital.

Methods: We retrospectively analyzed prospectively collected data of the patients, who underwent ECMO-assisted ventricular tachycardia or ventricular fibrillation ablation during 3 years, between 01.2015 and 12.2017 in large tertiary center.

Results: During 3-years study period, ECMO-assisted VT/VF ablation was performed in 14 patients. Eleven patients were preplanned to ECMO support before procedure and three patients were connected to ECMO during procedure due to hemodynamic instability. Mean ECMO time was 5.8±14.7 hours. In all patients we use veno-arterial approach: cannulation of femoral artery and femoral vein. All patients were decanulated, 12 in the catetheterization laboratory and 2 in Cardiac Surgery ICU. In patients with VF, premature ventricular complex suppression was achieved in 8 of 9 (89%). In those with VT, noninducibility was achieved in 7 of 9 (78%). One patient died after procedure.

Conclusion: Extracorporeal membrane oxygenation provides a haemodynamically stable and safe platform for VT/VF ablation.