Conclusion
To date, there are no ACC/AHA/HRS/EHRA recommendations regarding PVIs or atrial arrhythmia ablations on mechanical circulatory support. Most of the literature on mechanical support with Impella has been centered around its use in hemodynamically unstable ventricular tachycardia ablations.
The use of the Impella CP for PVI/PWI allows adequate time for exit block testing and also posterior wall isolation with radiofrequency ablation after antral cryoablation of the pulmonary vein. It frees the operator’s mind to do thorough mapping and ablation with the assurance that the patient is receiving adjustable support based on hemodynamic demands during the procedure.