Catheter Ablation Of Electrical Storm Research Articles

Characteristics and Outcome of Patients with or without Previous Implantable Cardioverter Defibrillator Interventions Undergoing Ablation for Ventricular Tachycardia.

Background: Catheter ablation (CA) is a well-established treatment in patients with ventricular tachycardia and appropriate implantable cardioverter defibrillator (ICD) therapies. Methods: We enrolled 57 consecutive carriers of ICD undergoing CA for electrical storm (ES). Our aim was to investigate differences in clinical, device-related, and electroanatomic features among patients who had history of appropriate ICD interventions before the ES compared to those who had not. The primary endpoint was a composite of death from any cause and recurrences of sustained VT, ventricular fibrillation, appropriate ICD therapy, or ES. Results: During a median follow up of 39 months, 28 patients (49%) met the primary endpoint. Those with previous ICD interventions had a higher prevalence of late potentials and a greater unipolar low-voltage area at electroanatomic mapping. Patients who met the primary endpoint had a higher prevalence of ATP/shock episodes preceding the ES event. At Cox regression analysis, non-ischemic dilated cardiomyopathy (NIDCM), QRS duration, and previous ATP and/or shock before the ES were associated with arrhythmic recurrences and/or death. At multivariate analysis, NIDCM and previous shock were associated with arrhythmic recurrences and/or death. Conclusions: A history of recurrent ICD therapies predicts worse outcomes when CA is needed because of ES. Although more studies are needed to definitively address this question, our data speak in support of an early referral for CA of ES.

Impact of Catheter Ablation of Electrical Storm on Survival: A Propensity Score-Matched Analysis

BackgroundElectrical storm (ES) is a life-threatening condition, associated with substantial early and subacute mortality. Catheter ablation (CA) is a well-established therapy for ES. However, data regarding the impact of CA on the short-term and midterm survival of patients admitted for ES remain unclear. ObjectivesThis multicenter study aimed to investigate the impact of CA of ES on survival outcomes, while accounting for key patient characteristics associated with treatment selection. MethodsA propensity score–matching (PSM) analysis was performed on 780 consecutive patients admitted for ES in 4 tertiary centers. PSM (1:1) based on the main characteristics associated with the use of CA or medical therapy alone was performed, resulting in 2 groups of 288 patients. ResultsAfter PSM, patients who underwent CA (n = 288) and those treated with medical therapy alone (n = 288) did not present any significant differences in the main demographic characteristics, ES presentation, and management. Compared with medical therapy alone, CA was associated with a significantly lower rate of ES recurrence at 1 year (5% vs 26%; P < 0.001). Similarly, CA was associated with a higher 1-year (91% vs 81%; P < 0.001) and 3-year (78% vs 71%; P = 0.017) survival after discharge. In subgroup analyses, effect of ablation therapy remained consistent in patients older than 70 years of age (HR: 0.39; 95% CI: 0.24-0.66), with substantial efficacy in patients with a LVEF <35% (HR: 0.39; 95% CI: 0.27-0.59). ConclusionsIn propensity-matched analyses, this large study shows that CA-based management of patients admitted for ES is associated with a reduction in mortality compared with medical treatment, particularly in patients with a low ejection fraction.

Non-revascularized chronic total occlusion is associated with worse outcomes in post-MI drug-refractory electrical storm patients treated by catheter ablation

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Outcomes in post-myocardial infarction (MI) patients which are referred for catheter ablation (CA) for drug-refractory electrical storm (ES) are influenced both by patient characteristics and procedural results. Previous data has shown higher risk for the first incident ES episode in the presence of non-revascularized chronic total occlusions (nCTOs). However, the prognostic effect of nCTOs in post-ES ablation patients is relatively unknown. Purpose We evaluated the impact of the presence of nCTO on all-cause mortality and sustained VT recurrence rate after CA for ES in post-MI patients. Methods In this single centre retrospective longitudinal study, we included consecutive post-MI patients referred for CA for drug-refractory ES. The median follow-up interval was 34.36 (7.25-63.65) months. CA outcome was defined by the absence or presence of residual sustained monomorphic VT at end-procedural programmed ventricular stimulation (PVS). Coronary angiography was performed prior to ablation in all patients. Results Sixty-four patients were included (85.9% (n = 55) males, age 62.64 ± 11.13 years). The mean left ventricular ejection fraction (LVEF) was 31.41 ± 10.99. There were 18.8% (n = 12) patients with nCTOs. Residual sustained monomorphic VT inducibility was documented in 28.1% (n = 18) cases. There were 29.7% (n = 19) deaths and sustained VT recurrences, respectively, during the monitored interval. Nine out of twelve (75%) nCTO patients died during follow-up. The presence of a nCTO induced a borderline significant higher risk of sustained VT recurrence during follow-up (HR 2.527, CI.95% 0.992 – 6.435, p = 0.052) in univariable Cox regression. In addition to age and residual sustained monomorphic VT at PVS, a multivariable Cox regression model identified the presence of nCTO as an independent predictor for all-cause mortality (HR 3.194, CI 95% 1.212-8.420, p = 0.019) (Figure 1). Conclusion(s) The presence of a nCTO in post-MI patients may be associated with higher all-cause mortality and sustained VT recurrences after ablation for drug-refractory electrical storm.

Prognosis at one year after urgent catheter ablation for electrical storm in patients with scar-related left ventricular cardiomyopathy

Electrical storm (ES) is a severe event in patients with scar-related left ventricular cardiomyopathy. Prognosis factors of ventricular arrhythmias (VA) recurrence and death after catheter ablation (CA) are not clearly identified in this population. Aims of this study is to identify prognosis factor of VA recurrences and death at 30 days and one year after CA. Patients with scar-related left ventricular cardiomyopathy hospitalised for urgent CA for ES in four tertiary referral university hospitals (AP–HP, Paris) were retrospectively included. Patients’ characteristics, ES management and one-year follow-up were collected. In total, 124 patients with scar related left ventricular cardiomyopathy who underwent urgent CA for ES were included. Polymorphic VA (HR = 2.15 95% CI [1.16–3.97], P = 0.02) was independently associated with VA recurrences at 30 days. Dilated cardiomyopathy (DCM) was associated with VA recurrences (HR = 2.25 95% CI [1.31–3.87], P = 0.003) whereas beta-blockers at baseline were associated with less VA recurrences (HR = 0.46 95% CI [0.26–0.83], P = 0.01) at one year. PAINESD Score (HR = 1.09 95% CI [1.01–1.19], P = 0.04) and need for circulatory support (HR = 4.20 95% CI [1.81–9.75], P = 0.04) were associated with 30 day-mortality. PAINESD Score (HR = 1.10 95% CI [1.03–1.16], P = 0.003), DCM (HR = 3.52 95% CI [1.75–7.08], P < 0.0001) and circulatory support (HR = 3.55 95% CI [1.83–6.84], P < 0.0001) were associated with one year-mortality. At one year, 22% of patients who underwent cardiac graft and 50% with long-term LVAD died. Polymorphic VA is associated with VA recurrence at 30 days. PAINESD score was significantly associated with early and late mortality. Patients with DCM presented a higher risk of VA recurrence and death at one year.

Catheter ablation of electrical storm in patients with arrhythmogenic right ventricular cardiomyopathy

Therapeutic strategies for electrical storm (ES) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) are not well defined. The purpose of this study was to report the acute and long-term results of ventricular tachycardia (VT) radiofrequency catheter ablation (RFCA) as a treatment of ES in patients with ARVC. This multicenter study retrospectively enrolled 23 consecutive patients with ARVC (mean age 43.6 ± 16.7 years; all men) who underwent 24 RFCA procedures for ES between 2003 and2015. Thirteen patients (57%) had a previous VT RFCA procedure; 14 (61%) had right ventricular dysfunction and 7 (30%) left ventricular ejection fraction ≤ 50%. The clinical VT was inducible in 19 procedures (79%). Epicardial ablation was performed in 4 procedures (17%). The median number of targeted VTs was 1 (range 1-6). Complete acute success (no VT inducible) was achieved in 11 procedures (46%) and partial acute success (clinical VT nor inducible) in 11 (46%). After a median follow-up of 3.9 years (range 1 month-10 years), ES recurred in 2 patients and end-stage heart failure developed in 4 (17%), leading to 1 death and 3 heart transplantations. At 1-year follow-up, the probability of freedom from VT recurrence was 75% and did not significantly predict long-term survival. At the last evaluation, 8 patients (35%) were free of non-β-blocker antiarrhythmic drugs as compared with 1 (4%) at baseline (P = .02). Catheter ablation was efficient to prevent ES recurrence in patients with ARVC. However, these patients were at high risk of evolution toward ARVC-related heart failure that was not associated with VT recurrence.

073_16801-Q1 Successfull Catheter Ablation of Electrical Storm in Patient With Non-Compaction Cardiomyopathy

We report a patient with non-compaction cardiomyopathy and preserved left ventricular systolic function presenting with an electrical storm triggered by premature ventricular contractions; originating from right ventricular free wall. Electrical storm did not respond to antiarrythmic drugs and could

Outcomes of rescue cardiopulmonary support for periprocedural acute hemodynamic decompensation in patients undergoing catheter ablation of electrical storm

In patients with ventricular tachycardia or ventricular fibrillation (VT/VF) electrical storm (ES) undergoing catheter ablation (CA), hypotension due to refractory VT/VF, use of anesthesia, and cardiac stunning due to repeated implantable cardioverter-defibrillator shocks might precipitate acute hemodynamic decompensation (AHD). We evaluated the outcomes of emergent cardiopulmonary support with extracorporeal membrane oxygenation (ECMO) to rescue AHD in patients undergoing CA of ES. Between January 1, 2010 and December 31, 2016, 21 patients with ES (VT in 11 and premature ventricular complex-triggered VF in 10) were referred for CA and had periprocedural AHD requiring emergent ECMO support. In 14 patients, AHD occurred a mean of 1.5 ± 1.7 days before the procedure. In the remaining 7 patients, AHD occurred during or shortly after the procedure. ECMO was started successfully in all patients. Ablation was performed in 18 patients (9 with VF and 9 with VT). In patients with VF, premature ventricular complex suppression was achieved in 8 of 9 (89%). In those with VT, noninducibility was achieved in 7 of 9 (78%). After a median follow-up of 10 days, 16 patients died (13 during the index admission). Death was due to refractory VT/VF in 4 patients, heart failure in 11, and noncardiac cause in 1 patient. Seven patients survived beyond 6 months postablation; 5 remained free of VT/VF and 3 ultimately received a destination therapy (heart transplantation in 2 and left ventricular [LV] assist device in 1). In patients with ES undergoing CA, the outcomes of ECMO support as rescue intervention for AHD are poor. The majority of these patients die of refractory heart failure in the short-term. Strategies to prevent AHD including preemptive use of hemodynamic support may improve survival.

Prediction and prognosis of ventricular tachycardia recurrence after catheter ablation with remote magnetic navigation for electrical storm in patients with ischemic cardiomyopathy.

Ventricular tachycardia (VT) recurrence after catheter ablation for electrical storm is commonly seen in patients with ischemic cardiomyopathy (ICM). We hypothesized that VT recurrence can be predicted and be related to the all-cause death after VT storm ablation guided by remote magnetic navigation (RMN) in patients with ICM. A total of 54 ICM patients (87% male; mean age, 65 ± 7.1 years) presenting with VT storm undergoing acute ablation using RMN were enrolled. Acute complete ablation success was defined as noninducibility of any sustained monomorphic VT at the end of the procedure. Early VT recurrence was defined as the occurrence of sustained VT within 1 month after the first ablation. After a mean follow-up of 17.1 months, 27 patients (50%) had freedom from VT recurrence. Sustained VT recurred in 12 patients (22%) within 1 month following the first ablation. In univariate analysis, VT recurrence was associated with incomplete procedural success (hazard ratio [HR]: 6.25, 95% confidence interval [CI]: 1.20-32.47, P = 0.029), lack of amiodarone usage before ablation (HR: 4.71, 95% CI: 1.12-19.7, P = 0.034), and a longer procedural time (HR: 1.023, 95% CI: 1.00-1.05, P = 0.05). The mortality of patients with early VT recurrence was higher than that of patients without recurrence (P < 0.01). Inducibility of any VT at the end of procedure for VT storm guided by RMN is the strongest predictor of VT recurrence. ICM patients who have early recurrences after VT storm ablation are at high risk of all-cause death.

Catheter ablation for electrical storm in Brugada syndrome: Results of substrate based ablation

BackgroundBrugada syndrome (BrS) is known to cause malignant ventricular arrhythmia (VA) and sudden cardiac death (SCD). Patients with implantable cardioverter defibrillator (ICD) may experience recurrent shocks from ICD. Recent reports indicate that radiofrequency ablation (RFA) in BrS is feasible, and effective. Catheter ablation of premature ventricular complexes (PVCs) triggering VA and substrate modification of right ventricular outflow tract (RVOT) has been described. Methods and resultsFive patients (4 males, age-23 to 32 years) with BrS and electrical storm (ES) despite being on isoprenaline infusion and cilostazol (phosphodiestrase-3 inhibitor) underwent 3 dimensional electroanatomic mapping and RFA. Ventricular fibrillation was easily inducible in two patients. Voltage map of right ventricle was created in sinus rhythm in all patients. Substrate modification of RVOT was performed endocardially in one patient, both endocardial and epicardial in three and only epicardially in one patient. Brugada pattern gradually resolved over one week in all patients post procedure. These patients completed follow up of median 40 months (1.5–70). One patient had inappropriate shock due to atrial fibrillation, one had an episode of VF and appropriate shock 24 months after the RFA. The remaining four patients had no device therapy or VA in device log on follow up. ConclusionAbnormal myocardial substrate is observed in RVOT among patients with BrS. Substrate modification in these patients may abolish Brugada pattern on the ECG and prevents spontaneous VAs on long term follow up.

Catheter ablation of electrical storm triggered by purkinje related premature ventricular contraction in patient with recent myocardial infarction

Catheter ablation of electrical storm triggered by purkinje related premature ventricular contraction in patient with recent myocardial infarction

Catheter ablation of drug refractory electrical storm in patients with ischemic cardiomyopathy: A single center experience.

Objective:Electrical storm (ES) is a life-threatening pathology that requires immediate and effective treatment due to increased morbidity and mortality. Catheter ablation (CA) is an effective therapeutic option, particularly in patients with drug resistant ventricular arrhythmia episodes. These procedures should only be performed in highly specialized and experienced centers. Here we aimed to assess safety and efficacy of CA in a relatively large cohort with ES in our tertiary center hospital.Methods:A total of 44 patients (90.9% male; mean age: 59.7±10.3 years) with ischemic cardiomyopathy undergoing CA for drug-refractory ES were prospectively evaluated. Procedures were performed using non-contact and electro-anatomic mapping systems. Long-term follow-up analysis addressed the predictors of ES recurrence and cardiac mortality.Results:Acute success rates for clinical and non-clinical VTs were 90.8% and 55.5%, respectively. A mean follow-up at 28±11 months revealed cardiac mortality in 8 (18%) patients, 39 (88.6%) patients were free from the ES, and 24 (55%) patients remained free from both ES and paroxysmal VT episodes. In multivariate regression analysis, recurrence of ES (OR=3.11, 95% CI: 1.65-4.62, p=0.001), LVEF, and serum creatinine were found as independent predictors of cardiac mortality. In addition, substrate based ablation, implantation of ICD for secondary prophylaxis, LVEF, and serum creatinine were good predictors of ES recurrence.Conclusion:Catheter ablation for ventricular arrhythmias in the course of ES in patients with ischemic cardiomyopathy is safe with an acceptable success rate. (Anatol J Cardiol 2016; 16: 159-64)

Precordial QRS amplitude ratio predicts long-term outcome after catheter ablation of electrical storm due to ventricular tachycardias in patients with arrhythmogenic right ventricular cardiomyopathy

BackgroundRadiofrequency catheter ablation is currently considered as the therapeutic option of choice in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and recurrent ventricular tachycardia (VT). MethodsThis study intended to assess the long-term outcome of catheter ablation in patients with ARVC and electrical storm. The specific objective was to assess the relationship between precordial QRS amplitude ratio and outcome of catheter ablation in these patients. ResultsTwenty-eight patients (19 men, age 52.3±14.2years) underwent 48 catheter ablation procedures (range 1–6, six epicardial). During a mean follow-up of 18.7±15.1months, 13 patients (46.5%) experienced VT recurrence. Age >50years and ∑QRSmvV1–V3/∑QRSmvV1–V6≤0.48 but not right ventricular size and acute ablation outcome were associated with VT recurrence during the follow up. ConclusionAge >50years and ∑QRSmvV1–V3/∑QRSmvV1–V6≤0.48 predict recurrence of VT after successful radiofrequency catheter ablation of VT in patients with ARVC and electrical storm.

Catheter ablation of electrical storm triggered by monomorphic ventricular ectopic beats after myocardial infarction

Catheter ablation of electrical storm triggered by monomorphic ventricular ectopic beats after myocardial infarction

HEART's Original [症例] 虚血性心疾患に合併したelectricalstormにカテーテルアブレーションが奏効した1例

HEART's Original [症例] 虚血性心疾患に合併したelectricalstormにカテーテルアブレーションが奏効した1例

Catheter ablation of electrical storm

Electrical storm (ES) is defined as the occurrence of ≥ three distinct episodes of ventricular arrhythmia (VA) in patients with implanted defibrillators within 24 h. Whereas conventional strategies for acute rhythm stabilization may be effective in some patients the occurrence of ES impairs survival and predicts recurrent VA. Catheter ablation in the setting of ES is complex and involves decisive strategies for individualized ablation approaches adapted to the patient’s cardiac abnormalities. Success rates have been documented to be between 79 and 94% in larger studies and effective ablation improves survival and freedom from any VA. Ablation should be considered early in the treatment plan and availability may be improved by interhospital collaboration with highly experienced VA intervention centers.

Catheter Ablation of Electrical Storm in a Collaborative Hospital Network

An electrical storm (ES) is defined as multiple ventricular arrhythmia episodes leading to implantable cardioverter defibrillator interventions. Although conventional rhythm stabilization might be of help acutely, ES involves high mortality and morbidity. We evaluated the effect of catheter ablation strategies in the setting of an interhospital collaborative network on the recurrence of ventricular arrhythmia episodes and mortality in patients with ES. Consecutive patients presenting for invasive treatment of ES from December 2007 to December 2009 were included. All patients underwent catheter ablation of ventricular arrhythmia. The strategies were adapted to the individual cardiac pathologic features. The follow-up examination constituted periodic implantable cardioverter defibrillator interrogation. A total of 32 patients were included. Of the 32 patients, 29 (91%) had monomorphic ventricular tachycardia and 3 ventricular fibrillation. The mean number of implantable cardioverter defibrillator-treated episodes within 7 days before ablation was 16 ± 11. Of the 32 patients, 27 underwent ablation within 24 hours after admission, and 5 underwent acute ablation within 8 hours. In 3 patients, epicardial ablation was performed. In all but 2 patients (6%), the clinical arrhythmia was successfully ablated. During a median follow-up of 15 months, 10 patients (31%) had recurrences of sustained ventricular arrhythmia, including 2 patients (6%) with recurrent ES. Three patients (9%) died during the follow-up period. In conclusion, catheter ablation effectively suppressed ventricular arrhythmia midterm recurrences in patients presenting with ES. Catheter ablation is complex in these severely sick patients. The recurrence rate of ventricular arrhythmia appears to be 31% and the mortality rate to be 9%. Collaborative hospital networks to increase the prompt availability of ES ablation might help to optimize the ES outcome.

Catheter Ablation of Electrical Storm Due to Monomorphic Ventricular Tachycardia in Patients with Nonischemic Cardiomyopathy: Acute Results and Its Effect on Long‐Term Survival

Electrical storm due to recurrent ventricular tachycardia (VT) in patients with implantable cardioverter defibrillator (ICD) can adversely affect their long-term survival. This study evaluates the efficiency of the radiofrequency catheter ablation of electrical storm due to monomorphic VT in patients with idiopathic dilated cardiomyopathy (DCM) and assesses its long-term effects on survival. Between April 2004 and October 2008, 13 consecutive patients (nine men, mean age 56.8 ± 17.8 years) with DCM and electrical storm due to monomorphic VT who had ICD underwent 17 catheter ablation procedures, including four epicardial, at our center. Acute complete success was defined as the lack of inducibility of any VT at the end of procedure during programmed right ventricular stimulation and was achieved in eight patients (61.5%). During a median follow-up of 23 months (range 3-63 months) nine patients (69%) were alive and eight patients (61.5%) were free from VT recurrence. Among those with acute complete (n = 8) and partial (n = 5) success, seven patients (87.5%) and one patient (20%) were free from any VT recurrence and ICD therapy, respectively (P = 0.025). Among those with acute complete and partial success, seven patients (87.5%) and two patients (40%) were alive, respectively (Mantel-Cox test P = 0.082). Among those who had an initially failed endocardial ablation (n = 8), four underwent further epicardial ablation that was completely successful in three patients (75%). Catheter ablation in patients with DCM and electrical storm due to monomorphic VT who had an ICD prevents further VT recurrence in 61.5% of the patients. Complete successful catheter ablation may play a protective role and was associated with reduced mortality during the follow-up period. More aggressive ablation strategies in patients with initially failed endocardial ablation might improve the long-term survival of these patients; however, further studies are needed to clarify this issue.

Catheter ablation of electrical storm in patients with structural heart disease

Electrical storm (ES) adversely affects prognosis of patients and may become a life-threatening event. Catheter ablation (CA) has been proposed for the treatment of ES. Our goal was to evaluate the efficacy of CA ablation both in acute and long-term suppression of ES. Fifty consecutive patients with coronary artery disease (38), idiopathic dilated cardiomyopathy (5), arrhythmogenic right ventricular cardiomyopathy (6), and/or with combined aetiology (1) underwent CA for ES. Mean left ventricular ejection fraction (LVEF) was 29 ± 11%. All patients underwent electroanatomical mapping, and CA was performed to abolish all inducible ventricular arrhythmias. The ES was suppressed by CA in 84% of patients. During the follow-up of 18 ± 16 months, 24 patients had no recurrences of any ventricular tachycardia (VT; 48%). Repeated procedure was necessary to suppress the recurrent ES in 13 cases (26%). Statistical analysis revealed that low LVEF (22 ± 3 vs. 31 ± 12%; P < 0.001), increased LVend-diastolic diameter (72 ± 9.1 vs. 64 ± 8.9 mm; P = 0.0135), and renal insufficiency (P < 0.001) were the univariate predictors of early mortality or necessity for heart transplantation. Recurrence of ES despite previous CA procedure was associated with a higher risk of death or heart transplant during follow-up (P < 0.05). Catheter ablation is effective in acute suppression of ES and often represents a life-saving therapy. In the long term, it prevents recurrences of any VT in about half of the treated patients.

Catheter Ablation for Electrical Storm as Polymorphic Ventricular Tachycardia in a Case with Ischemic Cardiomyopathy after Coronary Artery Bypass Graft

We report a case involving a patient with ischemic cardiomyopathy who developed polymorphic ventricular tachycardia (PVT) and ventricular fibrillation storm after coronary artery bypass graft. Because PVT was initiated by various right bundle branch type premature ventricular contractions (PVCs), we assessed the relatively monomorphic ventricular tachycardia (MVT) during PVT. Electroanatomical mapping revealed that the earliest ventricular activation of the MVT was located in the scar border zone at the posterior septum of the left ventricle. Stable potentials which preceded the MVT were observed. Catheter ablation for the preceding potential suppressed the maintenance of the PVT, although triggered PVCs appeared frequently. Catheter ablation was effective as a bailout therapy in a patient with PVT‐induced cardiomyopathy after cardiac operation.

Catheter Ablation for Electrical Storm as Polymorphic Ventricular Tachycardia in a Case with Ischemic Cardiomyopathy after Coronary Artery Bypass Graft

Catheter Ablation for Electrical Storm as Polymorphic Ventricular Tachycardia in a Case with Ischemic Cardiomyopathy after Coronary Artery Bypass Graft