Preemptive left ventricular hemodynamic support in ventricular tachycardia ablation: a systematic review and meta-analysis

Abstract Background The benefit of preemptive mechanical circulatory support (MCS) for ventricular tachycardia (VT) ablation remains unclear. This meta-analysis compared the efficacy and safety of preemptive left ventricular (LV) support to standard care for VT ablation. Methods An unrestricted literature search of Ovid MEDLINE, Embase, and Web of Science identified studies on preemptive MCS for VT ablation. MCS included percutaneous LV assist devices or extracorporeal membrane oxygenation. The primary endpoint was all-cause mortality; secondary endpoints included procedural time, procedural complications (vascular access, bleeding, stroke, pericardial effusion, heart failure, myocardial infarction, acute kidney injury), and 30-day major adverse cardiovascular events (MACE). Results Nine studies with 2,271 patients (417 with MCS, 1,854 without) were included. Mean follow-up was 15.2 months, mean age was 62.6 years, 12.5% were women, and mean PAAINESD scores were 9.7 in each group. There was no significant difference in all-cause mortality (OR 1.26, 95% CI 0.46-3.44, p=0.65) (Figure 1a). Preemptive MCS was associated with longer procedural times (mean difference 46.0 minutes, 95% CI. 11.1-80.8, p=0.01), more procedural complications--driven by vascular access, effusion, and acute kidney injury (OR 2.79, 95% CI 1.53-5.07, p0.001), and a trend towards increased 30-day MACE (OR 3.20, 95% CI 0.98-10.38, p=0.054) (Figure 1b-1d). Conclusions Preemptive LV hemodynamic support had a neutral effect on all-cause mortality in patients undergoing VT ablation but was associated with longer procedures, more procedural complications, and a trend towards increased 30-day MACE.