title: Feasibility and safety of catheter ablation of electrical storm in ischemic dilated cardiomyopathy.
abstract: OBJECTIVE
  Electrical storm is an emergency in 'implantation of a cardioverter defibrillator' carriers with ischemic dilated cardiomyopathy (DCM) and negatively impacts long-term prognosis. We evaluated the feasibility, safety, and effectiveness of radiofrequency catheter ablation (RFCA) in controlling electrical storm and its impact on survival and ventricular tachycardia/fibrillation recurrence.
  
  
  METHODS
  We enrolled 27 consecutive patients (25 men, age 73.1 ± 6.5 years) with ischemic DCM and an indication to RFCA for drug-refractory electrical storm. The immediate outcome was defined as failure or success, depending on whether the patient's clinical ventricular tachycardia could still be induced after RFCA; electrical storm resolution was defined as no sustained ventricular tachycardia/ventricular fibrillation in the next 7 days.
  
  
  RESULTS
  Of the 27 patients, 1 died before RFCA; in the remaining 26 patients, a total of 33 RFCAs were performed. In all 26 patients, RFCA was successful, although in 6/26 patients (23.1%), repeated procedures were needed, including epicardial ablation in 3/26 (11.5%). In 23/26 patients (88.5%), electrical storm resolution was achieved. At a follow-up of 16.7 ± 8.1 months, 5/26 patients (19.2%) had died (3 nonsudden cardiac deaths, 2 noncardiac deaths) and 10/26 patients (38.5%) had ventricular tachycardia recurrence; none had electrical storm recurrence. A worse long-term outcome was associated with lower glomerular filtration rate, wider baseline QRS, and presence of atrial fibrillation before electrical storm onset.
  
  
  CONCLUSIONS
  In patients with ischemic DCM, RFCA is well tolerated, feasible and effective in the acute management of drug-refractory electrical storm. It is associated with a high rate of absence of sustained ventricular tachycardia episodes over the subsequent 7 days. After successful ablation, long-term outcome was mainly predicted by baseline clinical variables.
authors.affiliation: aCardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan bDepartment of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy cTexas Cardiac Arrhythmia Institute at St David's Medical Center, Austin, Texas, USA dCardiac Arrhythmia and Heart Failure Research Institute, St Camillo-Forlanini Hospital, Rome eDepartment of Cardiovascular Sciences, University of Milan, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Dello Russo
authors.forename: Michela
authors.initials: M
authors.lastname: Casella
authors.forename: Gemma
authors.initials: G
authors.lastname: Pelargonio
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.forename: Stefano
authors.initials: S
authors.lastname: Bartoletti
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Bencardino
authors.forename: Ghaliah
authors.initials: G
authors.lastname: Al-Mohani
authors.forename: Ester
authors.initials: E
authors.lastname: Innocenti
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Andrea
authors.initials: A
authors.lastname: Avella
authors.forename: Augusto
authors.initials: A
authors.lastname: Pappalardo
authors.forename: Corrado
authors.initials: C
authors.lastname: Carbucicchio
authors.forename: Fulvio
authors.initials: F
authors.lastname: Bellocci
authors.forename: Cesare
authors.initials: C
authors.lastname: Fiorentini
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.forename: Claudio
authors.initials: C
authors.lastname: Tondo
mesh_terms: D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000209:etiology / Q000601:surgery*