Short-term mechanical circulatory supports (MCS) are used to stabilize patients with severe cardiogenic shock (CS). Catheter ablation may be an option to suppress recurrent arrhythmias preventing MCS weaning. We retrospectively analysed a dedicated registry to identify CS patients who underwent a catheter ablation between January 2020 and August 2024 for treatment resistant and hemodynamically significant arrhythmias while being on the MCS. Patients with supraventricular and ventricular tachycardias (SVT/VT) were analysed separately. Nine patients (8 males, 69 [IQR 60;74] years) were ablated for a refractory VT. Impella CP was used in 6 patients, VA ECMO in 2 patients, and 1 patient was on ECPELLA. Seven patients (78%) were successfully weaned off the MCS after the catheter ablation. 3 patients (33%) died within 30 days. The arrhythmia recurred in 5 patients (56%). Significant complications of MCS were reported in 6 patients (66%). The catheter ablation was complicated in one patient. SVT ablation was performed in 4 patients (3 males, 73 [IQR 67; 78] years, 1x VA ECMO, 2x Impella CP, 1x Impella 5.5). Three patients with atrial fibrillation were treated by a non-selective AV node ablation (pace and ablate strategy). One patient underwent an ablation of focal atrial tachycardia. The MCS was successfully explanted in all patients and no patient died in 30 days. The MCS use was complicated in one patient. Catheter ablation of refractory arrhythmias in CS patients treated by MCS is a safe and feasible approach to facilitate the MCS weaning process.

2nd Department of Medicine Department of Cardiovascular Medicine 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Prague Czech Republic

Institute for Heart Diseases Wroclaw Medical University Wrocław Poland

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Arrigo M, Price S, Baran DA, Pöss J, Aissaoui N, Bayes-Genis A, et al. Optimising clinical trials in acute myocardial infarction complicated by cardiogenic shock: a statement from the 2020 Critical Care Clinical Trialists Workshop. Lancet Respir Med. 2021;9(10):1192–202. doi: 10.1016/S2213-2600(21)00172-7 PubMed DOI

Sattler SM, Skibsbye L, Linz D, Lubberding AF, Tfelt-Hansen J, Jespersen T. Ventricular Arrhythmias in First Acute Myocardial Infarction: Epidemiology, Mechanisms, and Interventions in Large Animal Models. Front Cardiovasc Med. 2019;6:158. doi: 10.3389/fcvm.2019.00158 PubMed DOI PMC

Aissaoui N, Puymirat E, Delmas C, Ortuno S, Durand E, Bataille V, et al. Trends in cardiogenic shock complicating acute myocardial infarction. Eur J Heart Fail. 2020;22(4):664–72. doi: 10.1002/ejhf.1750 PubMed DOI

Cherbi M, Roubille F, Lamblin N, Bonello L, Leurent G, Levy B, et al. One-year outcomes in cardiogenic shock triggered by ventricular arrhythmia: An analysis of the FRENSHOCK multicenter prospective registry. Front Cardiovasc Med. 2023;10:1092904. doi: 10.3389/fcvm.2023.1092904 PubMed DOI PMC

Tavazzi G, Dammassa V, Colombo CNJ, Arbustini E, Castelein T, Balik M, et al. Mechanical circulatory support in ventricular arrhythmias. Front Cardiovasc Med. 2022;9:987008. doi: 10.3389/fcvm.2022.987008 PubMed DOI PMC

Volle K, Delmas C, Rollin A, Voglimacci-Stephanopoli Q, Mondoly P, Cariou E, et al. Successful Reversal of Severe Tachycardia-Induced Cardiomyopathy with Cardiogenic Shock by Urgent Rhythm or Rate Control: Only Rhythm and Rate Matter. J Clin Med. 2021;10(19):4504. doi: 10.3390/jcm10194504 PubMed DOI PMC

Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022;43(40):3997–4126. doi: 10.1093/eurheartj/ehac262 PubMed DOI

Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314–414. doi: 10.1093/eurheartj/ehae176 PubMed DOI

Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomström-Lundqvist C, et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J. 2020;41(5):655–720. doi: 10.1093/eurheartj/ehz467 PubMed DOI

McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Rev Esp Cardiol (Engl Ed). 2022;75(6):523. doi: 10.1016/j.rec.2022.05.005 PubMed DOI

Vahdatpour C, Collins D, Goldberg S. Cardiogenic Shock. J Am Heart Assoc. 2019;8(8):e011991. doi: 10.1161/JAHA.119.011991 PubMed DOI PMC

Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(17):1757–80. doi: 10.1016/j.jacc.2021.12.011 PubMed DOI

Laghlam D, Benghanem S, Ortuno S, Bouabdallaoui N, Manzo-Silberman S, Hamzaoui O, et al. Management of cardiogenic shock: a narrative review. Ann Intensive Care. 2024;14(1):45. doi: 10.1186/s13613-024-01260-y PubMed DOI PMC

Møller JE, Engstrøm T, Jensen LO, Eiskjær H, Mangner N, Polzin A, et al. Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock. N Engl J Med. 2024;390(15):1382–93. doi: 10.1056/NEJMoa2312572 PubMed DOI

Mariani S, Napp LC, Lo Coco V, Delnoij TSR, Luermans JGLM, Ter Bekke RMA, et al. Mechanical circulatory support for life-threatening arrhythmia: A systematic review. Int J Cardiol. 2020;308:42–9. doi: 10.1016/j.ijcard.2020.03.045 PubMed DOI

Kautzner J, Hašková J, Stojadinovič P, Peichl P, Wichterle D. Percutaneous mechanical support in catheter ablation of ventricular arrhythmias: hype or hope?. Europace. 2024;26(7):euae186. doi: 10.1093/europace/euae186 PubMed DOI PMC

Baratto F, Pappalardo F, Oloriz T, Bisceglia C, Vergara P, Silberbauer J, et al. Extracorporeal Membrane Oxygenation for Hemodynamic Support of Ventricular Tachycardia Ablation. Circ Arrhythm Electrophysiol. 2016;9(12):e004492. doi: 10.1161/CIRCEP.116.004492 PubMed DOI

Santangeli P, Rame JE, Birati EY, Marchlinski FE. Management of Ventricular Arrhythmias in Patients With Advanced Heart Failure. J Am Coll Cardiol. 2017;69(14):1842–60. doi: 10.1016/j.jacc.2017.01.047 PubMed DOI

Muser D, Liang JJ, Castro SA, Hayashi T, Enriquez A, Troutman GS, et al. Outcomes with prophylactic use of percutaneous left ventricular assist devices in high-risk patients undergoing catheter ablation of scar-related ventricular tachycardia: A propensity-score matched analysis. Heart Rhythm. 2018;15(10):1500–6. doi: 10.1016/j.hrthm.2018.04.028 PubMed DOI

Mascia G, Barca L, Sartori P, Bianco D, Della Bona R, Di Donna P, et al. Provisional Circulatory Support with Extracorporeal Membrane Oxygenation during Ventricular Tachycardia Ablation in Intermediate Risk Patients: A Case Series. J Clin Med. 2024;13(15):4477. doi: 10.3390/jcm13154477 PubMed DOI PMC

Ballout JA, Wazni OM, Tarakji KG, Saliba WI, Kanj M, Diab M, et al. Catheter Ablation in Patients With Cardiogenic Shock and Refractory Ventricular Tachycardia. Circ Arrhythm Electrophysiol. 2020;13(5):e007669. doi: 10.1161/CIRCEP.119.007669 PubMed DOI PMC

Cheruvu C, Walker B, Kuchar D, Subbiah RN. Successful ablation of incessant AV reentrant tachycardia in a patient on extracorporeal membrane oxygenation. Heart Lung Circ. 2014;23(1):e12-5. doi: 10.1016/j.hlc.2013.06.011 PubMed DOI

Mantini N, Zipse M, Tompkins C, Varosy PD, Sauer WH, Nguyen DT. Ablation of atrial arrhythmias in patients with cardiogenic shock on mechanical circulatory support. HeartRhythm Case Rep. 2018;5(3):115–9. doi: 10.1016/j.hrcr.2018.11.008 PubMed DOI PMC

Scheinman MM, Huang S. The 1998 NASPE prospective catheter ablation registry. Pacing Clin Electrophysiol. 2000;23(6):1020–8. doi: 10.1111/j.1540-8159.2000.tb00891.x PubMed DOI

Curtis AB, Kutalek SP, Prior M, Newhouse TT. Prevalence and characteristics of escape rhythms after radiofrequency ablation of the atrioventricular junction: results from the registry for AV junction ablation and pacing in atrial fibrillation. Ablate and Pace Trial Investigators. Am Heart J. 2000;139(1 Pt 1):122–5. doi: 10.1016/s0002-8703(00)90318-1 PubMed DOI

Subramaniam AV, Barsness GW, Vallabhajosyula S, Vallabhajosyula S. Complications of Temporary Percutaneous Mechanical Circulatory Support for Cardiogenic Shock: An Appraisal of Contemporary Literature. Cardiol Ther. 2019;8(2):211–28. doi: 10.1007/s40119-019-00152-8 PubMed DOI PMC

Ali JM, Abu-Omar Y. Complications associated with mechanical circulatory support. Ann Transl Med. 2020;8(13):835. doi: 10.21037/atm.2020.03.152 PubMed DOI PMC

Ostadal P, Rokyta R, Karasek J, Kruger A, Vondrakova D, Janotka M, et al. Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock: Results of the ECMO-CS Randomized Clinical Trial. Circulation. 2023;147(6):454–64. doi: 10.1161/CIRCULATIONAHA.122.062949 PubMed DOI

Miller MA, Dukkipati SR, Koruth JS, d’Avila A, Reddy VY. How to perform ventricular tachycardia ablation with a percutaneous left ventricular assist device. Heart Rhythm. 2012;9(7):1168–76. doi: 10.1016/j.hrthm.2012.02.005 PubMed DOI