TY - JOUR
T1 - Mechanical circulatory support for life -threatening arrhythmia
T2 - A systematic review
AU - Mariani, Silvia
AU - Napp, L. Christian
AU - Lo Coco, Valeria
AU - Delnoij, Thijs S. R.
AU - Luermans, Justin G. L. M.
AU - ter Bekke, Rachel M. A.
AU - Timmermans, Carl
AU - Li, Tong
AU - Dogan, Guenes
AU - Schmitto, Jan D.
AU - Maessen, Jos
AU - Maesen, Bart
AU - Lorusso, Roberto
PY - 2020/6/1
Y1 - 2020/6/1
N2 - The use of temporary mechanical circulatory support (tMCS) during arrhythmia is increasing, although available evidence for this indication is limited, with significant gaps of knowledge regarding appropriate timing, management and configuration. This systematic review sought to analyze the use of tMCS in patients with life-threatening arrhythmia.A systematic literature search identified 2529 references published until September 2019. Adult and pediatric patients diagnosed with all kind of life-threatening arrhythmia were included. tMCS was primarily compared to conventional non-tMCS therapies. Primary outcome measure was in-hospital or 30-day mortality.19 non-randomized studies were selected, including 2465 adult and 82 pediatric patients. Primary outcome in tMCS patients varied widely (4-62%) with differences based on the use of prophylactic tMCS (4-21%) or rescue tMCS (58-62%). A substantial mortality benefit was observed among high-risk patients, as identified with PAINESD risk score or suffering from electrical storm and treated with prophylactic tMCS. During ablation procedures, tMCS patients showed higher rates of induced ventricular tachycardias (VTs), ablated VTs, VT termination and non-inducibility after ablation. Extracorporeal membrane oxygenation (ECMO) was applied in pediatric cases as hemodynamic protection for aggressive antiarrhythmic medical treatment with >80% survival.Prophylactic tMCS is associated with improved survival as compared to rescue or no-tMCS in patients with life-threatening arrhythmia, and may be considered in patients with high PAINESD risk score or suffering from electrical storm. ECMO can be advised as rescue and support therapy in pediatric cases requiring aggressive antiarrhythmic medical treatment.Copyright © 2020 Elsevier B.V. All rights reserved.
AB - The use of temporary mechanical circulatory support (tMCS) during arrhythmia is increasing, although available evidence for this indication is limited, with significant gaps of knowledge regarding appropriate timing, management and configuration. This systematic review sought to analyze the use of tMCS in patients with life-threatening arrhythmia.A systematic literature search identified 2529 references published until September 2019. Adult and pediatric patients diagnosed with all kind of life-threatening arrhythmia were included. tMCS was primarily compared to conventional non-tMCS therapies. Primary outcome measure was in-hospital or 30-day mortality.19 non-randomized studies were selected, including 2465 adult and 82 pediatric patients. Primary outcome in tMCS patients varied widely (4-62%) with differences based on the use of prophylactic tMCS (4-21%) or rescue tMCS (58-62%). A substantial mortality benefit was observed among high-risk patients, as identified with PAINESD risk score or suffering from electrical storm and treated with prophylactic tMCS. During ablation procedures, tMCS patients showed higher rates of induced ventricular tachycardias (VTs), ablated VTs, VT termination and non-inducibility after ablation. Extracorporeal membrane oxygenation (ECMO) was applied in pediatric cases as hemodynamic protection for aggressive antiarrhythmic medical treatment with >80% survival.Prophylactic tMCS is associated with improved survival as compared to rescue or no-tMCS in patients with life-threatening arrhythmia, and may be considered in patients with high PAINESD risk score or suffering from electrical storm. ECMO can be advised as rescue and support therapy in pediatric cases requiring aggressive antiarrhythmic medical treatment.Copyright © 2020 Elsevier B.V. All rights reserved.
KW - VENTRICULAR-TACHYCARDIA ABLATION
KW - EXTRACORPOREAL MEMBRANE-OXYGENATION
KW - CATHETER ABLATION
KW - INFANTS
KW - PREDICTORS
KW - MANAGEMENT
KW - OUTCOMES
KW - IMPACT
U2 - https://doi.org/10.1016/j.ijcard.2020.03.045
DO - https://doi.org/10.1016/j.ijcard.2020.03.045
M3 - (Systematic) Review article
SN - 0167-5273
VL - 308
SP - 42
EP - 49
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -