Abstract
PurposeRadiofrequency catheter ablation (RFCA) for electrical storm (ES) has become a widely used therapeutic method. Its effectiveness in comparison to other forms of ES treatment is however uncertain.MethodsThis single-centre retrospective study investigated the long-term clinical outcome after RFCA for ES and compared long-time effects of ablation to other forms of treatment. The study population consisted of 70 consecutive patients hospitalised between January 2010 and June 2015 due to ES. Patients were recruited for the study if the following criteria were fulfilled: first ES caused by ventricular tachycardia (VT) or ventricular fibrillation (VF), implanted cardioverter defibrillator or cardiac resynchronisation therapy device and left ventricular ejection fraction < 50%. The follow-up data on VT/ES recurrence was obtained from pacemaker/implanted cardioverter defibrillator memory. Data on all-cause mortality was collected during outpatient visits or by telephone contact.ResultsOf the 70 patients enrolled, 28 (40%) were treated with RFCA (group A) and 42 (60%) received other forms of treatment for ES (group B). During a mean (±SD) 864 (629) days of follow-up, death occurred in 4 (14.3%) patients in the ablation group and in 16 (38.1%) patients treated with other methods [p = 0.03]. There was no significant between-group difference in VT/VF and ES recurrence. Statistical analysis revealed that the presence of cardiac resynchronisation therapy device during ES, stroke and/or transient ischaemic attack and lower baseline hematocrit level were the multivariate predictors of all-cause mortality.ConclusionsIn patients treated with RFCA for ES, all-cause mortality was significantly lower compared to the group treated with other methods.
Highlights
Heart failure (HF) is a growing medical problem in developed countries, with incidences among adult population reaching up to 2% [1]
The recommended and most efficient form of primary and secondary prevention against sudden cardiac death in heart failure patients is the implantation of automatic implantable cardioverter defibrillators (ICD) [2, 3]. 3.5% of patients with an ICD for primary prevention, and even 10–40% of those implanted for secondary prevention of SCD, will suffer from the most malignant form of ventricular arrhythmia, known as an electrical storm (ES) [4, 5]
At a median followup of 22 months, ES recurred in 8% and cardiac mortality was significantly higher in patients in whom at least one clinical ventricular tachycardia (VT) could not be abolished, when compared with patients after successful catheter ablation (CA) defined as non-inducible VT in programmed electrical stimulation
Summary
Heart failure (HF) is a growing medical problem in developed countries, with incidences among adult population reaching up to 2% [1]. The recommended and most efficient form of primary and secondary prevention against sudden cardiac death in heart failure patients is the implantation of automatic implantable cardioverter defibrillators (ICD) [2, 3]. 3.5% of patients with an ICD for primary prevention, and even 10–40% of those implanted for secondary prevention of SCD, will suffer from the most malignant form of ventricular arrhythmia, known as an electrical storm (ES) [4, 5]. J Interv Card Electrophysiol (2017) 50:227–234 energy therapies within a short-time period Management in this challenging group is generally focused on the elimination of potentially reversible causes of electrical instability, haemodynamic stabilisation and (once reversible causes have been excluded or dampened) modification of the arrhythmogenic substrate with catheter ablation of ventricular tachycardia [7,8,9].
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