The role of catheter ablation in the management of patients with implantable cardioverter defibrillators presenting with electrical storm

摘要

Abstract Objective Electrical storm (ES) is not uncommon among patients with an implantable cardioverter defibrillator (ICD) in situ. Catheter ablation (CA) may suppress the arrhythmia in the acute setting and prevent {ES} recurrence. Methods Nineteen consecutive patients with an {ICD} in situ presenting with {ES} underwent electrophysiologic studies followed by CA. {CA} outcome was classified as a complete success if both clinical and non-clinical tachycardia were successfully ablated, partial success if ≥1 non-clinical tachycardia episodes were still inducible post–CA, and failure if clinical tachycardia could not be abolished. Patients were followed for a median period (IQR) of 5.6 (1.8-13.7) months. The primary endpoint was event-free survival from {ES} recurrence. The secondary endpoint was event-free survival from a composite of {ES} and/or sustained ventricular tachycardia (VT) recurrence. Results Clinical arrhythmia was successfully ablated in 14 out of 19 (73.7%) cases after a single {CA} procedure. A completely successful {CA} outcome was associated with significantly increased ES-free survival compared with a partially successful or failed procedure (Log rank P=0.039). Nevertheless, patients with acute suppression of all tachycardia episodes (n=11), relative to those with a partially successful or a failed {CA} procedure (n=8), did not differ in incidence of the composite endpoint of sustained {VT} or {ES} (Log rank P=0.278). Conclusion A single {CA} procedure can acutely suppress clinical arrhythmia in three-quarters of cases. A completely successful {CA} outcome can prolong ES-free survival; however, sporadic {ICD} therapies cannot be abrogated.