Impact of Intraprocedural Pressor Use on Catheter Ablation for
Ventricular Tachycardia
Abstract
Background: Ventricular tachycardia (VT) remains a leading cause of
morbidity and sudden death. Improvements in catheter ablation have
significantly advanced this option as a treatment method for refractory
VT. Despite advances, use and impact of inotrope and vasodepressor
medicines as part of intraprodcedural management during VT ablation have
been understudied. Methods: We conducted a exploratory, retrospective
analysis of consecutive patients undergoing VT ablation. Patient, intra
and peri-procedural data, focusing on pressor use and hemodynamics
through ablation, and procedural endpoint data were collected. Results:
From 2014-2017, 149 patients underwent VT ablation of which 67%
exhibited cardiomyopathy (53% ischemic). Most procedures (71%) were
conducted under general anesthesia. In those with cardiomyopathy,
steady-state use of dobutamine and dopamine was more common though
substantial use of phenylephrine was noted. In adjusted analyses, (1)
dobutamine was associated with increased procedure time (402.5±18.8 vs
347.2±14.0 min, p = 0.03), (2) dopamine was associated with increased
number of distinct VTs (2.8 vs. 2.2, p<0.001) while both
dopamine and dobutamined resulted in increased intra-procedural
cardioversions (1.3 vs. 0.6, p<0.001 and 1.34 vs. 0.66,
p=0.001, respectively) and (3) dobutamine dose exhibited a linear
correlation with post-ablation length of stay. Conclusions: In this
exploratory work, we sought to understand effects of hemodynamic drug
use on short-term, procedural outcomes of VT ablation. Salient findings
include: (1) arrhythmogenic nature of inotropes resulting in an increase
in intraprocedural cardioversions, (2) greater propensity for induction
of non-clinical VTs with use of intraprocedural dopamine and (3)
substantial use of phenylephrine in those with underlying
cardiomyopathy.