Outcomes after catheter ablation for treatment of electrical storm in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia

Abstract

Catheter ablation is an effective treatment for ARVC/D-associated ventricular tachycardia (VT), however its benefit as an urgent treatment for electrical storm (ES) remains to be assessed. Report the acute and long-term results of catheter ablation in patients with ARVC/D presenting with ES. Consecutive patients with a diagnosis of ARVC/D who underwent urgent catheter ablation for ES from five different French centers were retrospectively included. Between 2003 and 2015, 23 patients with ARVC/D (mean age 43.6 ± 16.7 years) underwent 24 VT catheter ablation procedures for ES. Median time from ARVC diagnosis to ES was 3.4 years [−4.4–39.2]. A total of 53% of patients had previous VT ablation and 78% had an implantable cardioverter-defibrillator. All but 2 patients were on beta-blockers and/or antiarrhythmic therapy. Four patients presented with cardiogenic shock. Diffuse RV structural abnormalities was present in 70% of patients, 61% had RV systolic dysfunction and 35% of patients had left ventricular ejection fraction < 50%. Only 8% of patients had more than 1 documented VT whereas 63% had multiple induced sustained VT. The clinical VT was inducible in 79% of the procedures. The median number of targeted VTs and sites were 1 [1–6] and 1 [1–5], respectively. Acute success defined as inability to induce any sustained VT was obtained in 53% but the clinical VT remained non-inducible in 100% of procedures. At 1 follow-up year, cumulative probability of freedom from VT recurrence was 75%. During a median follow-up time of 3.9 years (1 month–10 years), only one ES reoccurred when 17% patients developed end-stage heart failure with one death and three hearts transplantation unrelated to arrhythmia. Catheter ablation is efficient in reducing the arrhythmic burden in patients with advanced ARVC/D presenting with ES. However, ES could be associated with poor homodynamic long-term outcome.