Outcomes of Scar-Related Ventricular Tachycardia Ablation With Percutaneous Left Ventricular Assist Device Support

Background: Percutaneous left ventricular assist devices (pLVADs) are often used in critically ill patients undergoing scar-related ventricular tachycardia (VT) ablation. However, there are no randomized controlled trials evaluating their benefits. Objectives: The goal of this study was to compare outcomes between pLVAD- and non-pLVAD–supported VT ablation using a propensity score matching analysis. Methods: This retrospective analysis comprised 481 scar-related VT patients who underwent catheter ablation (175 pLVAD and 306 non-pLVAD). A 1:1 propensity score matching was conducted to balance baseline characteristics for comparison of procedural and long-term outcomes. Results: A propensity score analysis generated 115 matched pairs in each group. Baseline characteristics of the matched cohorts were comparable (mean left ventricular ejection fraction 27%, 40% NYHA functional class ≥III, and 36% electrical storm). Compared with the non-pLVAD, more patients in the pLVAD group had at least 1 VT termination during ablation. Despite including a higher use of advanced ablation strategies and a longer procedure time, the pLVAD group had a postprocedural VT inducibility similar to that of the non-pLVAD group. The incidence of periprocedural major complications was higher among pLVAD patients (29.6% vs 13.9%; P = 0.004), largely driven by vascular complications requiring intervention and periprocedural heart failure. During a median follow-up of 326 days, Kaplan-Meier curves showed no statistically significant differences in composite outcome (hospitalization for VT or worsening heart failure requiring hospitalization, LVAD implantation, orthotopic heart transplantation, and all-cause mortality), and VT recurrence. Conclusions: The use of pLVADs during VT ablation is associated with longer procedures and higher procedural complications without any benefit in acute or long-term outcomes.