Electrical storm might be the initial presentation of arrhythmogenic right ventricular cardiomyopathy.

To the Editor,

We read with great interest the paper by Özcan et al. (1) entitled “Catheter ablation of drug refractory electrical storm in patients with ischemic cardiomyopathy: A single center experience,” published as Epub ahead of print in The Anatolian Journal of Cardiology 2015. They aimed to evaluate the safety and efficacy of catheter ablation in a relatively large cohort with the electrical storm. We congratulate the authors for the successful clinical management of these patients.

The electrical storm can be defined as ≥3 life-threatening ventricular arrhythmia within a 24-h period and may cause implantable cardioverter defibrillator discharges, resulting in morbidity and mortality. The electrical storm in adults with ischemic heart fai-

lure is common. However, the electrical storm might be the initial presentation of arrhythmogenic right ventricular cardiomyopathy (ARVC), although ARVC usually presents with sustained ventricular tachycardia or sudden cardiac death (2). Moreover, some patients with ARVC may have unusual presentations such as acute coronary syndrome or heart failure (3). In clinical practice, if ARVC is not considered as a possible cause of ventricular arrhythmias, the diagnosis might be overlooked because of the requirement of a different diagnostic approach for the diagnosis of ARVC according to the modified criteria (4). In the study by Özcan et al. (1), it would be better to evaluate the patients for cardiomyopathies, including ARVC, in terms of diagnostic and therapeutic management.

Although ventricular tachycardia frequency is reduced after catheter ablation, the incidence of rapid ventricular arrhythmia during long-term follow-up is still common in patients with ARVC. In addition, catheter ablation may not be able to cure ventricular arrhythmia in ARVC, and cardiac transplantation can be the only choice for the treatment of the electrical storm in a patient with ARVC (5). In this large cohort with the electrical storm reported by Özcan et al. (1), it will be valuable to determine whether some patients have undergone cardiac transplantation because of the electrical storm.