Catheter ablation of hemodynamically unstable ventricular tachycardia with mechanical circulatory support Fei Lü, Peter M. Eckman, Kenneth K. Liao, Ioanna.

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Catheter ablation of hemodynamically unstable ventricular tachycardia with mechanical circulatory support Fei Lü, Peter M. Eckman, Kenneth K. Liao, Ioanna Apostolidou, Ranjit John, Taibo Chen, Gladwin S. Das, Gary S. Francis, Han Lei, Richard G. Trohman, David G. Benditt International Journal of Cardiology Volume 168, Issue 4, Pages 3859-3865 (October 2013) DOI: 10.1016/j.ijcard.2013.06.035 Copyright © 2013 The Authors Terms and Conditions

Fig. 1 Arterial blood pressure recordings during ventricular tachycardia (VT) in 3 typical patients under different methods of mechanical circulatory support (MCS). Hemodynamic support was considered adequate during VT when mean arterial pressure was maintained above 60mmHg with MCS. Mean arterial pressure (MAP) during VT tended to be lower during Impella support compared with peripheral cardiopulmonary bypass (pCPB) and continuous flow left ventricular assist device (CF-LVAD). International Journal of Cardiology 2013 168, 3859-3865DOI: (10.1016/j.ijcard.2013.06.035) Copyright © 2013 The Authors Terms and Conditions

Fig. 2 Mapping and ablation of ventricular tachycardia (VT) in a patient under peripheral cardiopulmonary bypass (pCPB). This VT was mapped to the anteroseptal left ventricle toward the base as shown by Carto mapping (top left) and fluoroscopy in posteroanterior projection (top right). This episode of VT was terminated within 2s after radiofrequency ablation. Please note pre-systolic and diastolic potentials at successful ablation site in Carto map display. Another successful ablation site was located at the anteroseptal left ventricle toward the apex. Surface lead I and arterial blood pressure are shown at bottom. International Journal of Cardiology 2013 168, 3859-3865DOI: (10.1016/j.ijcard.2013.06.035) Copyright © 2013 The Authors Terms and Conditions

Fig. 3 Arterial and coronary sinus (CS) lactate level during ablation of ventricular tachycardia (VT) with peripheral cardiopulmonary bypass (CPB) support. (A) It is noted that both arterial and CS lactate level increased during transient hypotension. While mean arterial pressure (MAP) was maintained above 60mmHg (79mmHg in this patient), lactate level stayed in the normal range. It appears that CS lactate level parallels well with arterial lactate level with correlation coefficient of 0.89, suggesting that arterial lactate level can be used to monitor cardiac lactate production as well as systematic production. (B) Arterial lactate remained essentially stable over a 90min VT period for mapping and ablation. See text for a detailed discussion. Proc = procedure. International Journal of Cardiology 2013 168, 3859-3865DOI: (10.1016/j.ijcard.2013.06.035) Copyright © 2013 The Authors Terms and Conditions

Fig. 4 Cerebral tissue regional oxygen saturation (rSO2) in a patient under CPB support for unstable VT ablation. A sample of one-hour cerebral rSO2 display is shown at the top. Cerebral rSO2 was approximately between 40% and 50% (bottom graph) during electrophysiologic preparation. At approximately 12:00pm, fast VT at 182bpm with systolic arterial pressure down to 40mmHg was induced and pace-terminated after approximately 25s. After establishing CPB, VT was induced again targeted for mapping and ablation. In total, this patient was on CPB for 116min and in VT for 55min. International Journal of Cardiology 2013 168, 3859-3865DOI: (10.1016/j.ijcard.2013.06.035) Copyright © 2013 The Authors Terms and Conditions