Catheter ablation of electrical storm in patients with structural heart disease.
OBJECTIVE
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.


RESULTS
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).


CONCLUSIONS
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.
Department of Cardiology, Institute for Clinical and Experimental Medicine, Videnska 1958/9, Prague 4 140 21, Czech Republic. mrkz@ikem.cz
Marketa
M
Kozeluhova
Petr
P
Peichl
Robert
R
Cihak
Dan
D
Wichterle
Vlastimil
V
Vancura
Jan
J
Bytesnik
Josef
J
Kautzner
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000453:epidemiology; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000453:epidemiology; D017115:Catheter Ablation; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000150:complications / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*