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Noninvasive neurological monitoring to enhance pLVAD-assisted ventricular tachycardia ablation – a Mini review

For critically ill patients, hemodynamic fluctuations can be life-threatening; this is particularly true for patients experiencing cardiac comorbidities. Patients may suffer from problems with heart contractility and rate, vascular tone, and intravascular volume, resulting in hemodynamic instability...

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Autores principales: De Potter, Tom, Valeriano, Chiara, Buytaert, Dimitri, Bouchez, Stefaan, Ector, Joris
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10031079/
https://www.ncbi.nlm.nih.gov/pubmed/36970357
http://dx.doi.org/10.3389/fcvm.2023.1140153
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author De Potter, Tom
Valeriano, Chiara
Buytaert, Dimitri
Bouchez, Stefaan
Ector, Joris
author_facet De Potter, Tom
Valeriano, Chiara
Buytaert, Dimitri
Bouchez, Stefaan
Ector, Joris
author_sort De Potter, Tom
collection PubMed
description For critically ill patients, hemodynamic fluctuations can be life-threatening; this is particularly true for patients experiencing cardiac comorbidities. Patients may suffer from problems with heart contractility and rate, vascular tone, and intravascular volume, resulting in hemodynamic instability. Unsurprisingly, hemodynamic support provides a crucial and specific benefit during percutaneous ablation of ventricular tachycardia (VT). Mapping, understanding, and treating the arrhythmia during sustained VT without hemodynamic support is often infeasible due to patient hemodynamic collapse. Substrate mapping in sinus rhythm can be successful for VT ablation, but there are limitations to this approach. Patients with nonischemic cardiomyopathy may present for ablation without exhibiting useful endocardial and/or epicardial substrate-based ablation targets, either due to diffuse extent or a lack of identifiable substrate. This leaves activation mapping during ongoing VT as the only viable diagnostic strategy. By enhancing cardiac output, percutaneous left ventricular assist devices (pLVAD) may facilitate conditions for mapping that would otherwise be incompatible with survival. However, the optimal mean arterial pressure to maintain end-organ perfusion in presence of nonpulsatile flow remains unknown. Near infrared oxygenation monitoring during pLVAD support provides assessment of critical end-organ perfusion during VT, enabling successful mapping and ablation with the continual assurance of adequate brain oxygenation. This focused review provides practical use case scenarios for such an approach, which aims to allow mapping and ablation of ongoing VT while drastically reducing the risk of ischemic brain injury.
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spelling pubmed-100310792023-03-23 Noninvasive neurological monitoring to enhance pLVAD-assisted ventricular tachycardia ablation – a Mini review De Potter, Tom Valeriano, Chiara Buytaert, Dimitri Bouchez, Stefaan Ector, Joris Front Cardiovasc Med Cardiovascular Medicine For critically ill patients, hemodynamic fluctuations can be life-threatening; this is particularly true for patients experiencing cardiac comorbidities. Patients may suffer from problems with heart contractility and rate, vascular tone, and intravascular volume, resulting in hemodynamic instability. Unsurprisingly, hemodynamic support provides a crucial and specific benefit during percutaneous ablation of ventricular tachycardia (VT). Mapping, understanding, and treating the arrhythmia during sustained VT without hemodynamic support is often infeasible due to patient hemodynamic collapse. Substrate mapping in sinus rhythm can be successful for VT ablation, but there are limitations to this approach. Patients with nonischemic cardiomyopathy may present for ablation without exhibiting useful endocardial and/or epicardial substrate-based ablation targets, either due to diffuse extent or a lack of identifiable substrate. This leaves activation mapping during ongoing VT as the only viable diagnostic strategy. By enhancing cardiac output, percutaneous left ventricular assist devices (pLVAD) may facilitate conditions for mapping that would otherwise be incompatible with survival. However, the optimal mean arterial pressure to maintain end-organ perfusion in presence of nonpulsatile flow remains unknown. Near infrared oxygenation monitoring during pLVAD support provides assessment of critical end-organ perfusion during VT, enabling successful mapping and ablation with the continual assurance of adequate brain oxygenation. This focused review provides practical use case scenarios for such an approach, which aims to allow mapping and ablation of ongoing VT while drastically reducing the risk of ischemic brain injury. Frontiers Media S.A. 2023-03-08 /pmc/articles/PMC10031079/ /pubmed/36970357 http://dx.doi.org/10.3389/fcvm.2023.1140153 Text en © 2023 De Potter, Valeriano, Buytaert, Bouchez and Ector. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
De Potter, Tom
Valeriano, Chiara
Buytaert, Dimitri
Bouchez, Stefaan
Ector, Joris
Noninvasive neurological monitoring to enhance pLVAD-assisted ventricular tachycardia ablation – a Mini review
title Noninvasive neurological monitoring to enhance pLVAD-assisted ventricular tachycardia ablation – a Mini review
title_full Noninvasive neurological monitoring to enhance pLVAD-assisted ventricular tachycardia ablation – a Mini review
title_fullStr Noninvasive neurological monitoring to enhance pLVAD-assisted ventricular tachycardia ablation – a Mini review
title_full_unstemmed Noninvasive neurological monitoring to enhance pLVAD-assisted ventricular tachycardia ablation – a Mini review
title_short Noninvasive neurological monitoring to enhance pLVAD-assisted ventricular tachycardia ablation – a Mini review
title_sort noninvasive neurological monitoring to enhance plvad-assisted ventricular tachycardia ablation – a mini review
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10031079/
https://www.ncbi.nlm.nih.gov/pubmed/36970357
http://dx.doi.org/10.3389/fcvm.2023.1140153
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