Mid-term outcomes after catheter ablation in patients with electric storm

Introduction: Electric storm is a life-threatening con-dition, that can complicate multiple cardiac pathologies and is associated with high mortality. Radiofrequency ablation in an experienced center and a „heart team” approach are essential for patient survival. We present a single center experience from May 2015 to May 2019 with electric storm patients.

Objective: To determine the characteristics, treatment specifics and success rate of electric storm procedures. Methods: The study included 66 consecutive patients, mean age 60 years, 82% males, treated for electric storm in our center. Besides endocardial/endo-epicar-dial radiofrequency catheter ablation (with or witho-ut remote magnetic navigation) additional treatment methods included medical therapy, general anesthesia, implantable device optimization or cardiac sympathe-tic denervation (CSD). Acute success was defined as elimination of the clinical tachycardia with complete non-inducibility (including VF) or non-inducibility for monomorphic VT. Mean follow-up duration was 6 months and the type of recurrence was catalogued in 3 categories: initial VT (isolated), electric storm and other sustained VT

Results: The overall acute success rate was 93%, com-plete non-inducibility was proved in 64.5% and non-inducibility for monomorphic VT in 87.5% of the ca-ses. Epicardial approach was used in 43% of the non-ischaemic cases vs. 3% of the ischaemic ones (p=0.004). There were no significant differences between complete non-inducibility rates of the ischaemic vs. non-ischae-mic groups. Among the paraclinical variables analysed for predicting non-inducibility the mean QRS duration of the clinical tachycardia was significantly shorter in the group where complete non-inducibilty was obtai-ned: 160 ± 32ms vs. 240±63.3ms (p=0.02). Reccurent VT occurred in 19% of the patients during follow up, 27.2% initial VT (isolated), 36.4% electric storm and 36.4% other sustained VT. Death rate was 10.6%, 7 pa-tients from which, two during the same hospitalization, one due to a hemorrhagic complication after CSD and the other one with reccurent arrhythmias and five after a mean period of 20.7 ± 15 months due to refractory heart failure.

Conclusions: Ablative therapy in electric storm patient has a good success rate and acute survival rate in our study. Unsuccessfull ablation is associated with higher inhospital death rates. Shorter QRS duration during clinical VT could be a good predictor of better acute outcomes (complete-non-inducibility) but further stu-dies are necessary.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)