Long term results of catheter ablation in patients presented with ventricular storm

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background and Objective Catheter ablation is a treatment option in patients with ventricular tachycardia (VT storm, especially when refractory to medical treatment. In this trial, we aimed to evaluate the long-term results of catheter ablation in patients with VT storm. Method Between January 2015 and January 2022T, we enrolled a total of 65 VT storm patients who underwent catheter ablation. All patients who have either documented episodes of VT or appropriate ICD shocks more than 3in the last 24 hours. Medical treatment with antiarrhythmic drugs was given to all patients before catheter ablation. After the procedure, all-cause mortality, hospitalization due to stroke/myocardial infarction/heart failure, ICD shocks, and anti-tachycardia pacing therapies were recorded during follow-up. Results Among the whole study population (the median age is 65 years (17-85); 56 (86.2%) males) 37 (56.9%) had ischemic CMP, 24 (36.9%) had non-ischemic CMP whose 8 were ARVD, and 3 (4.6%) HCMP. The median left ventricle ejection fraction was 30% (12 – 65%). Activation mapping was performed in 60 patients, and the critical isthmus was ablated in 60 patients whose 22 had more than one critical ablation site. In 3 patients, only substrate mapping was performed, and substrate homogenization was done. In 2 patients, premature ventricular ectopy, which inducted VT, ablation was performed. Epicardial mapping was performed in 23 patients (35.4%). The median follow-up duration was 23 months (1-94 months). During follow-up, 23 patients died, 43 were hospitalized, and four presented again with VS storm. In 13 patients, appropriate shock/pacing therapy was observed. After the index procedure, re-do catheter ablation of ventricular tachycardia was performed in 8 patients. The mean postprocedural VT-free survival time was estimated at 76.5 months (SE:5.0, 95% CI: 66.6-86.4). Conclusion Catheter ablation therapy is an effective option for both acute and long-term management of patients with VT storms. However, postprocedural mortality and morbidity remain high in long-term follow-up duration. Long-term results may be related to the comorbidities and nature of underlying cardiac disorders.