title: Outcomes of ventricular tachycardia ablation in patients with structural heart disease: The impact of electrical storm.
abstract: OBJECTIVE
  To investigate predictors of long-term outcomes after catheter ablation (CA) for ventricular tachycardia (VT) and the impact of electrical storm (ES) prior to index ablation procedures.
  
  
  METHODS
  We studied consecutive patients with structural heart disease and VT (n = 328; age: 63±12 years; 88% males; 72% ischaemic cardiomyopathy; LVEF: 32±12%) who had undergone CA. According to presenting arrhythmia at baseline, they were divided into ES (n = 93, 28%) and non-ES groups. Clinical predictors of all-cause mortality were investigated and a clinically useful risk score (SCORE) was constructed.
  
  
  RESULTS
  During a median follow-up of 927 days (IQR: 564-1626), 67% vs. 60% of patients (p = 0.05) experienced VT recurrence in the ES vs. the non-ES group, respectively; and 41% vs. 32% patients died (p = 0.02), respectively. Five factors were independently associated with mortality: age >70 years (hazard ratio (HR): 1.6, 95% confidence interval (CI): 1.1-2.4, p = 0.01), NYHA class ≥3 (HR: 1.9, 95% CI: 1.2-2.9, p = 0.005), a serum creatinine level >1.3 mg/dL (HR: 1.6, 95% CI: 1.1-2.3, p = 0.02), LVEF ≤25% (HR: 2.4, 95% CI: 1.6-3.5, p = 0.00004), and amiodarone therapy (HR: 1.5, 95% CI: 1.0-2.2, p = 0.03). A risk SCORE ranging from 0-4 (1 point for either high-risk age, NYHA, creatinine, or LVEF) correlated with mortality. ES during index ablation independently predicted mortality only in patients with a SCORE ≤1.
  
  
  CONCLUSIONS
  Advanced LV dysfunction, older age, higher NYHA class, renal dysfunction, and amiodarone therapy, but not ES, were predictors of poor outcomes after CA for VT in the total population. However, ES did predict mortality in a low-risk sub-group of patients.
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic.
authors.forename: Bashar
authors.initials: B
authors.lastname: Aldhoon
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic.
authors.forename: Dan
authors.initials: D
authors.lastname: Wichterle
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Peichl
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic.
authors.forename: Robert
authors.initials: R
authors.lastname: Čihák
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic.
authors.forename: Josef
authors.initials: J
authors.lastname: Kautzner
mesh_terms: D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D017180:Tachycardia, Ventricular / Q000150:complications / Q000473:pathology / Q000601:surgery*; D014693:Ventricular Fibrillation / Q000150:complications*