Ventricular arrhythmia ablation was associated with a higher probability of successful ECMO weaning (cs-HR 1.72) compared to no ablation in patients with electrical storm-related cardiogenic shock.
Cohort (n=218)
Yes
Does ventricular arrhythmia ablation improve successful ECMO weaning in patients with electrical storm-related refractory cardiogenic shock supported by V-A ECMO?
In patients with electrical storm-related refractory cardiogenic shock on V-A ECMO, early ventricular arrhythmia ablation is associated with a significantly higher probability of successful ECMO weaning and myocardial recovery.
Effect estimate: cs-HR 1.72 (95% CI 1.08-2.73)
p-value: p=0.022
Electrical storm (ES) with refractory cardiogenic shock carries high mortality. While veno-arterial extracorporeal membrane oxygenation (V-A ECMO) may stabilize circulation, the role and timing of ventricular arrhythmia (VA) ablation under ECMO remain unclear. To assess the impact and optimal timing of VA ablation on ECMO weaning success in patients supported with V-A ECMO for ES-related refractory cardiogenic shock. We conducted a French multicenter retrospective cohort study including 218 patients treated between 2015 and 2023 in 9 tertiary centers. Patients requiring V-A ECMO for ES-related cardiogenic shock were included; 115 underwent VA ablation, and 103 did not. The primary endpoint was successful ECMO weaning, defined as liberation from ECMO alive without transition to durable mechanical circulatory support or heart transplantation 28 days after ECMO liberation. Analyses combined propensity-score matching, time-dependent Cox models, spline-based analysis, and landmark Fine p = 0.022). Spline-based Cox analysis indicated that the benefit was greatest when ablation was performed within the first days of support, progressively attenuating thereafter. Among ablated patients, early intervention (≤ Day 4) conferred a clear advantage over later ablation (HR 2.10, 95% CI 1.14–3.87; p = 0.01). A landmark Fine p = 0.0045). In patients with ES-related refractory cardiogenic shock supported by V-A ECMO, VA ablation was associated with a higher probability of successful ECMO weaning, particularly when performed within the early days after cannulation.
Saura et al. (Tue,) conducted a cohort in Electrical storm-related refractory cardiogenic shock requiring V-A ECMO (n=218). Ventricular arrhythmia (VA) ablation vs. No VA ablation was evaluated on Successful ECMO weaning (liberation from ECMO alive without transition to durable mechanical circulatory support or heart transplantation 28 days after ECMO liberation) (cs-HR 1.72, 95% CI 1.08-2.73, p=0.022). Ventricular arrhythmia ablation was associated with a higher probability of successful ECMO weaning (cs-HR 1.72) compared to no ablation in patients with electrical storm-related cardiogenic shock.