Table 3:
MCS support modalities and their role in catheter ablation for ES.
| Modality | Function | Advantages | Disadvantages |
|---|---|---|---|
|
| |||
| IABP | Inflation in diastole increases coronary perfusion; deflation during systole reduces afterload | Easy to place and widely available Lower risk of complications Unloads LV by reducing afterload |
Primarily effective in sinus rhythm Ineffective at higher heart rates or with non-sinus rhythms Contraindicated in patients with AI Modest hemodynamic support (increase in cardiac output & MAP) |
| Impella | A continuous-flow pump placed across the AV provides LV unloading and augments cardiac output | Relatively easy to place and widely available Significant increase in cardiac output: 3 L/min (CP) or 5 L/min (5.5) No reliance on sinus rhythm Directly unloads LV |
Requires surgical cut down (5.5) Contraindicated in AS or mechanical AV (must cross aortic valve) Crowded LVOT limits retro-aortic approach to ablation Can cause ventricular ectopy & EMI Does not provide RV support without use of a second device |
| TandemHeart | Arterial bypass system with transseptal LA access and external pump | Significant reduction in cardiac preload and workload Full cardiac output support Addition of oxygenation circuit is possible No reliance on sinus rhythm |
Not widely available Requires transseptal access (leaving a residual ASD) Large arterial and venous sheaths with risk of vascular complications Risk of LA thrombus and hemolysis Does not provide RV support without use of a second device |
| ECMO | Portable complete cardiopulmonary bypass | Full biventricular cardiac and pulmonary support No reliance on sinus rhythm Can be placed at bedside without fluoroscopy Can use either transseptal or retrograde aortic approach |
Large arterial and venous sheaths with risk of vascular complications Thromboembolic and bleeding risks Standard configurations increase left ventricular afterload |
AI, aortic insufficiency; AS, aortic stenosis; ASD, atrial septal defect; AV, aortic valve; DBP, diastolic blood pressure; ECMO, extracorporeal membrane oxygenation; EMI, electromagnetic interference; IABP, intraaortic balloon pump; LA, left atrium; LV, left ventricle; LVOT, left ventricular outflow tract; MAP, mean arterial pressure; RV, right ventricular.