Pasquale Vergara1, Roderick Tung2, Marmar Vaseghi3, Chiara Brombin4, David S Frankel5, Luigi Di Biase6, Koichi Nagashima7, Usha Tedrow7, Wendy S Tzou8, William H Sauer8, Nilesh Mathuria9, Shiro Nakahara10, Kairav Vakil11, Venkat Tholakanahalli11, T Jared Bunch12, J Peter Weiss12, Timm Dickfeld13, Rama Vunnam13, Dhanunjaya Lakireddy14, J David Burkhardt15, Anna Correra16, Pasquale Santangeli5, David Callans5, Andrea Natale15, Francis Marchlinski5, William G Stevenson7, Kalyanam Shivkumar3, Paolo Della Bella16. 1. San Raffaele Hospital, Milan, Italy. Electronic address: pasqualevergara@hotmail.com. 2. University of Chicago Medical Center, Chicago, Illinois. 3. UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California. 4. University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy. 5. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. 6. Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York. 7. Brigham and Women's Hospital, Boston, Massachusetts. 8. University of Colorado, Aurora, Colorado. 9. Baylor St. Luke's Medical Center/Texas Heart Institute, Houston, Texas. 10. Dokkyo Medical University Koshigaya Hospital, Saitama, Japan. 11. University of Minnesota Medical Center, Minneapolis VA Medical Center, Minneapolis, Minnesota. 12. Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah. 13. University of Maryland Medical Center, Baltimore, Maryland. 14. University of Kansas Medical Center, Kansas City, Kansas. 15. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas. 16. San Raffaele Hospital, Milan, Italy.
Abstract
OBJECTIVE: The purpose of this study was to evaluate the characteristics and outcome of patients undergoing ablation after electrical storm (ES). METHODS: Clinical and procedural characteristics, ventricular tachycardia (VT) recurrence, and mortality rates from 1940 patients undergoing VT ablation were compared between patients with and without ES. RESULTS: The group of 677 patients with ES (34.9%) were older, were more frequently men, and had a lower ejection fraction, more advanced heart failure, and a higher prevalence of cardiovascular comorbidities as compared with those without ES (86.1% patients with ES had ≥2 comorbidities vs 71.4%; P < .001). Patients with ES had more inducible VTs (2.5 ± 1.8 vs 1.9 ± 1.9; P < .001), required longer procedures (296.1 ± 119.1 minutes vs 265.7 ± 110.3 minutes; P < .001), and had a higher in-hospital mortality (42 deaths [6.2%] vs 18 deaths [1.4%]; P < .001). At 1-year follow-up, patients with ES experienced a higher risk of VT recurrence and mortality (32.1% vs 22.6% and 20.1% vs 8.5%; long-rank, P < .001 for both). Among patients with ES, those without any inducible VT after ablation had a higher survival rate (86.3%) than did those with nonclinical VTs only (72.9%), those with clinical VTs inducible at programmed electrical stimulation (51.2%), and not-tested patients (65.0%) (long-rank, P < .001 for all). In multivariate analysis, ES remained an independent predictor of in-hospital mortality, VT recurrence, and 1-year mortality (P < .001). CONCLUSION: Patients with ES have a high risk of VT recurrence and mortality. Patient and procedure characteristics are consistent with advanced cardiac disease and longer and more complex procedures. In patients with ES, acute procedural success is associated with a significant reduction in VT recurrence and improved 1-year survival.
OBJECTIVE: The purpose of this study was to evaluate the characteristics and outcome of patients undergoing ablation after electrical storm (ES). METHODS: Clinical and procedural characteristics, ventricular tachycardia (VT) recurrence, and mortality rates from 1940 patients undergoing VT ablation were compared between patients with and without ES. RESULTS: The group of 677 patients with ES (34.9%) were older, were more frequently men, and had a lower ejection fraction, more advanced heart failure, and a higher prevalence of cardiovascular comorbidities as compared with those without ES (86.1% patients with ES had ≥2 comorbidities vs 71.4%; P < .001). Patients with ES had more inducible VTs (2.5 ± 1.8 vs 1.9 ± 1.9; P < .001), required longer procedures (296.1 ± 119.1 minutes vs 265.7 ± 110.3 minutes; P < .001), and had a higher in-hospital mortality (42 deaths [6.2%] vs 18 deaths [1.4%]; P < .001). At 1-year follow-up, patients with ES experienced a higher risk of VT recurrence and mortality (32.1% vs 22.6% and 20.1% vs 8.5%; long-rank, P < .001 for both). Among patients with ES, those without any inducible VT after ablation had a higher survival rate (86.3%) than did those with nonclinical VTs only (72.9%), those with clinical VTs inducible at programmed electrical stimulation (51.2%), and not-tested patients (65.0%) (long-rank, P < .001 for all). In multivariate analysis, ES remained an independent predictor of in-hospital mortality, VT recurrence, and 1-year mortality (P < .001). CONCLUSION:Patients with ES have a high risk of VT recurrence and mortality. Patient and procedure characteristics are consistent with advanced cardiac disease and longer and more complex procedures. In patients with ES, acute procedural success is associated with a significant reduction in VT recurrence and improved 1-year survival.
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