title: Beyond the Storm: Comparison of Clinical Factors, Arrhythmogenic Substrate, and Catheter Ablation Outcomes in Structural Heart Disease Patients With versus Those Without a History of Ventricular Tachycardia Storm.
abstract: Catheter ablation can be lifesaving in ventricular tachycardia (VT) storm, but the underlying substrate in patients with storm is not well characterized. We sought to compare the clinical factors, substrate, and outcomes differences in patients with sustained monomorphic VT who present for catheter ablation with VT storm versus those with a nonstorm presentation.
  
  
  
  Consecutive ischemic (ICM; n = 554) or nonischemic cardiomyopathy patients (NICM; n = 369) with a storm versus nonstorm presentation were studied (ICM storm 186; NICM storm 101).
  
  
  
  In ICM, storm compared with nonstorm patients had significantly lower left ventricular (LV) ejection fraction (EF), greater number of antiarrhythmic drug (AAD) failures, slower VTs, greater number of scarred LV segments, higher incidence of anterior, septal, and apical endocardial LV scar (all P < 0.05). However, outcomes in follow-up were similar (12-month ventricular arrhythmia [VA]-free survival: 51% vs. 52%, P = 0.6; survival free of death/transplant 75% vs. 87%, P = 0.7). In addition to the above differences, NICM storm patients were also older; however, the extent and distribution of scar was similar except for a higher incidence of lateral endocardial scar in storm patients (P = 0.05). VA-free survival (36% vs. 47%, P = 0.004) and survival free of death/transplant, however, were worse in NICM storm than nonstorm patients (72% vs. 88%, P = 0.001). NICM storm patients had worse VA-free survival than ICM storm patients.
  
  
  
  There are differences in clinical factors and scar patterns in patients undergoing VT ablation who present with VT storm versus those with a nonstorm presentation. Clinical outcomes are worse in NICM storm patients.
authors: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: Saurabh
authors: S
authors: Kumar
authors: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: Akira
authors: A
authors: Fujii
authors: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: Sunil
authors: S
authors: Kapur
authors: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: Jorge
authors: J
authors: Romero
authors: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: Nishaki K
authors: NK
authors: Mehta
authors: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: Shinichi
authors: S
authors: Tanigawa
authors: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: Laurence M
authors: LM
authors: Epstein
authors: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: Bruce A
authors: BA
authors: Koplan
authors: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: Gregory F
authors: GF
authors: Michaud
authors: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: Roy M
authors: RM
authors: John
authors: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: William G
authors: WG
authors: Stevenson
authors: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: Usha B
authors: UB
authors: Tedrow
mesh_terms: D000200:Action Potentials; D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001900:Boston; D009202:Cardiomyopathies / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D017115:Catheter Ablation / Q000009:adverse effects; D002921:Cicatrix / Q000209:etiology / Q000503:physiopathology; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006339:Heart Rate; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: catheter ablation; electrical storm; ischemic cardiomyopathy; nonischemic cardiomyopathy; ventricular tachycardia