Ventricular Tachycardia in Children on Impella Support

Background: The Impella® (AbioMed,Inc.; Danvers, Massachusetts) device is a percutaneously delivered VAD that was developed for temporary support of the failing heart. It was designed primarily for adult patients but has also been adopted by physicians treating children in cardiogenic shock. We sought to describe the incidence and management of ventricular arrhythmias with Impella use as well as its impact on clinical outcomes.

Methods: A single-center retrospective analysis of children receiving an Impella device between 2014 and 2021 was performed. Patients with Impella for isolated right heart support were excluded.

Results: In total, there were 43 Impella implants in 37 patients. The median age at placement was 16 years (IQR 14-19). The median duration of support was 5 days (IQR 4-10). The reason for implantation included heart transplant rejection, transplant coronary artery disease, cardiomyopathy, myocarditis, complex congenital heart disease or tachyarrhythmias. In total, 23 patients (53.5%) had a ventricular arrhythmia while on Impella support, with 15 (35%) requiring pharmacological treatment. Fifteen of these patients had non-sustained VT, while 8 had sustained ventricular tachycardia. Antiarrhythmics used included metoprolol, sotalol, lidocaine and amiodarone. Of the 23 patients with VT, 12 (52.2%) of them required bedside interventions to reposition the device, including two patients requiring repositioning more than once. Of the patients who underwent successful explant of Impella without subsequent need for transplant or additional mechanical support, 9 (40.9%) continued to have ventricular arrhythmias post removal. There was no correlation between ventricular arrhythmia while on Impella support and risk of death, transplantation or need for further ventricular assist device (p=0.108).

Conclusion: Ventricular arrhythmias are common in children requiring Impella support, and may be related to mechanical irritation combined with diseased myocardium. VT was not associated with death, need for transplantation or durable VAD support. However, many patients continued to have VT post-explant. Continued therapy and monitoring even after support with Impella may be important as experience grows.