CATHETER ABLATION IN CARDIOGENIC SHOCK TREATED BY A MECHANICAL CIRCULATORY SUPPORT

Background: Mechanical circulatory supports (MCS) including VA ECMO and Impella devices provide hemodynamic stability for selected cardiogenic shock (CS) patients. Even though, recurrent arrhythmias complicate the treatment and worsen the prognosis.

Methodology: This is a retrospective analysis of a dedicated registry of patients who underwent a catheter ablation (CA) in our cardiac center between 01/2020 and 08/2024 while being treated with MCS for a CS. Both patients with SVTs and VTs were included but their data were analyzed separately. The main evaluated outcomes were the MCS weaning success rate and 30-day mortality.

Results: We identified 9 patients (8 males, median age 69 years) ablated for a refractory VT. ImpellaCP was used in 6 cases, 2 patients were on a VA ECMO and 1 patient was completely supported by ECPELLA. After the CA, 7 patients were successfully weaned off the MCS and 2 patients died in the 30 days after the CA. The VT reoccurred in 4 patients and a clinically significant complication of MCS was reported in 6 patients. The CA itself was complicated only in 1 patient by the need of a pacemaker implantation.
4 patients were ablated for torpid SVT while being on a MCS for CS (3 males, median age 73 years). 3 patients were treated by a non-selective AV node ablation following a CRT implantation. 1 patient underwent a radiofrequency ablation of a focal atrial tachycardia. The MCS was successfully explanted in all 4 patients and no patient died in 30 days. The MCS related hemolysis was reported in 1 patient.

Conclusion: CA for refractory arrhythmias in CS is feasible and can facilitate the MCS weaning process. The CA itself appears to be safe but the complications of MCS are common. Patients with VTs have worse prognosis than patients with SVTs and are in a high risk of arrhythmia recurrence even after the CA procedure.