Ventricular Tachycardia Radiofrequency Ablation with Extracorporeal Membrane Oxygenation – The Sheba Experience

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

Methods: Subjects with hemodynamically unstable, recurrent ventricular arrhythmias that were unresponsive to medical therapy underwent extracorporeal membrane oxygenation (ECMO) assisted RFCA of scar related VT. Clinical characteristics, history of arrhythmia, procedural detiles and outcomes were collected prospectively. All subjects 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 up to 4 L/min to allow hemodynamic stability and adequate systemic organ perfusion.

Results: A total of 45 patients (43% men, age 64±9) were ablated with ECMO support. Most has an ischemic cardiomyopathy (69%) and presented with VT storm. The clinical VT was induced in the majority of patients (75%). During a mean ECMO time of 3.5 hours a total of 95 VTs were induced of which 82 were ablated. Percutaneous epicardial approach was performed in 11 procedures. Most patients (86%) were de-cannulated by the end of the procedure. Non inducability was achieved in 81% of cases. A total of 4 patients died within a week of the procedure, 4 required blood products and 1 sustained a stroke. Over a median follow up of 100 days only 1 required a redo RFCA.

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