Prophylactic Mechanical Circulatory Support for Protected Ventricular Tachycardia Ablation A Meta‐Analysis of the Literature

Acute hemodynamic decompensation (AHD) during ventricular tachycardia (VT) ablation occurs in about 11% of cases. Prophylactic use of temporary mechanical circulatory support (pro-tMCS) has been applied to prevent AHD during VT ablation, but evidence supporting this practice is still lacking. This systematic review and meta-analysis assessed the procedural characteristics and outcomes of pro-tMCS for VT ablation. PubMed/Medline was screened until February 2020. Articles including adults receiving pro-tMCS for VT ablation were included, and a meta-analysis to compare proMCS and no-tMCS was performed. Primary outcome was in-hospital/30-day mortality. Five observational studies presenting 400 procedures (pro-tMCS: n=187; no-tMCS: n=213) were included. Baseline characteristics were comparable between groups. Impella and TandemHeart were used in 86.6% and 13.4% of cases, respectively. In the pro-tMCS group, more VTs were induced (mean difference:0.52, CI:0.26-0.77, p<0.0001), and patients remained in VT on average for 24.04 minutes longer (CI:18.28-29.80, p<0.00001). Procedural success was comparable between groups, as was VT recurrence. Pro-tMCS patients had an odds ratio of 0.55 (CI:0.28-1.05, p=0.07) for in-hospital/30 days mortality and 0.53 (CI:0.31-0.90, p=0.02) for mortality at follow-up. 6.4% of no-tMCS patients received rescue tMCS. The most common tMCS-related complications were bleeding events. Pro-tMCS allowed for a prolonged time on VTs and the induction of more VTs. While these advantages were not associated with differences in procedural success, VT recurrence or in-hospital/30-day mortality in the overall population, pro-tMCS might improve long-term survival but further prospective studies are urgently needed to confirm these results.