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Impact of Intraprocedural Pressor Use on Catheter Ablation for Ventricular Tachycardia
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  • Amneet Sandhu,
  • Jeffrey Graham,
  • MICHAEL ROSENBERG,
  • Matthew Zipse,
  • Alexis Tumolo,
  • Jose Sanchez,
  • John West,
  • Ryan Aleong,
  • Ryan Borne,
  • Paul Varosy,
  • William Sauer,
  • Wendy Tzou,
  • Duy Nguyen
Amneet Sandhu
University of Colorado

Corresponding Author:[email protected]

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Jeffrey Graham
University of Colorado
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MICHAEL ROSENBERG
University of Colorado Denver School of Medicine
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Matthew Zipse
University of Colorado
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Alexis Tumolo
University of Colorado
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Jose Sanchez
University of Colorado
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John West
University of Colorado Denver School of Medicine
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Ryan Aleong
University of Colorado
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Ryan Borne
University of Colorado
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Paul Varosy
Denver VA Medical Center
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William Sauer
Brigham and Women's Hospital
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Wendy Tzou
University of Colorado
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Duy Nguyen
Stanford University School of Medicine
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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.
27 Apr 2021Submitted to Journal of Cardiovascular Electrophysiology
28 Apr 2021Submission Checks Completed
28 Apr 2021Assigned to Editor
30 Apr 2021Reviewer(s) Assigned
23 May 2021Review(s) Completed, Editorial Evaluation Pending
01 Jun 2021Editorial Decision: Revise Minor