ECMO-Assisted Radiofrequency Ablation for Recurrent Ventricular Tachycardia: Case Series

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has emerged as a viable modality for supporting circulation in patients with severe ventricular arrhythmia and high risk of acute hemodynamic instability during radiofrequency ablation (RFA) procedure.

Objectives: (a) To demonstrate the feasibility and effectiveness of VA-ECMO as a mechanical circulatory support during radiofrequency ablation in patients with sustained-recurrent ventricular tachyarrhythmia, which allows to achieve control of arrhythmia and improves survival in this high-risk cohort; (b) to determine the patient-selection criteria for VA-ECMO.

Case reports. We analyzed 5 cases of sustained -recurrent ventricular tachycardia in patients (all men, mean age 59 years) who were hospitalized in the intensive care unit. All patients had multiple episodes of ventricular tachycardia despite continuous conservative therapy. Four patients underwent radiofrequency ablation of the arrhythmogenic substrate with VA-ECMO support, resulting in complete elimination of tachyarrhythmia. The patients were successfully weaned from ECMO and subsequently discharged. In the fifth patient with left ventricular ejection fraction of 17–20% due to dilated cardiomyopathy the invasive procedure was excluded due to the terminal stage of heart failure, extremely high perioperative risk, and anticipated RFA failure. After patient's condition stabilized, he was referred to a tertiary center for orthotopic heart transplantation (OHT).

Results. All patients who underwent ECMO-assisted RFA achieved complete control of arrhythmia without recurrence during the entire follow-up period. Successful weaning from ECMO and discharge from the hospital confirmed the effectiveness of this strategy. One case demonstrated the limitations of the method, i. e. in a patient with terminal myocardial damage RFA was considered palliative.

Conclusion. ECMO support during ablation procedure allows the use of RFA in patients with severe structural myocardial pathology and high risk of hemodynamic instability. Scrupulous selection of patients with localized arrhythmogenic substrate and the potential for restoring myocardial function after RFA are the key components for procedural success.

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