Catheter ablation of electrical storm in patients with structural heart disease

Abstract

AimsElectrical 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.Methods and resultsFifty 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 ± 9.1vs. 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).ConclusionCatheter 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. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2010.