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Percutaneous Hemodynamic Support with Impella 2.5 During Scar-Related Ventricular Tachycardia Ablation (PERMIT 1).
MedLine Citation:
PMID:  23255277     Owner:  NLM     Status:  Publisher    
BACKGROUND: -Percutaneous left ventricular assist devices (pLVADs) are increasingly being utilized to facilitate ablation of unstable ventricular tachycardia (VT), but the safety profile and hemodynamic benefits of these devices have not been described in a systematic, prospective manner. METHODS AND RESULTS: -Twenty patients with scar-VT underwent ablation with a pLVAD. Neuromonitoring utilizing cerebral oximetry was performed to evaluate a cerebral desaturation threshold to guide the duration of activation/entrainment mapping. The efficacy of pLVAD support was tested in a controlled manner with simulated VT. Complete procedural success was achieved in 50% (n=8) of patients who were initially inducible for sustained VT, and partial procedural success in 37% (n=6). Using a cerebral desaturation level of 55% as a lower safety limit to guide the duration of sustained VT, 3 patients (15%) developed mild acute kidney injury (all resolved), and 1 (5%) patient developed mild cognitive dysfunction. During fast simulated VT (300 ms), cerebral desaturation to ≤ 55% occurred in over half (53%) of patients tested without pLVAD support, compared to only 5% with full pLVAD support (p=0.003). CONCLUSIONS: -In a consecutive series of patients with severe left ventricular dysfunction, pLVAD-supported scar-VT ablation was safe and feasible. During fast simulated VT, a miniaturized axial flow pump imparted a more favorable hemodynamic profile compared to pharmacological agents alone. Cerebral oximetry is a complimentary monitoring modality during scar-VT ablation, and avoidance of cerebral desaturations below a threshold of 55% may safely guide the duration of mapping during unstable VT. Clinical Trials Registration; Identifier: NCT01294267.
Marc A Miller; Srinivas R Dukkipati; Jason S Chinitz; Jacob S Koruth; Alexander J Mittnacht; Craig Napolitano; Andre d'Avila; Vivek Y Reddy
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-19
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  -     ISSN:  1941-3084     ISO Abbreviation:  Circ Arrhythm Electrophysiol     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Mount Sinai School of Medicine, New York, NY.
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