Catheter Ablation for the Treatment of Electrical Storm in Patients With Implantable Cardioverter-Defibrillators

• DOI: 10.1161/circulationaha.106.686534
• Publication Date: 2008-01-03T01:59:14Z
• Authors: Corrado Carbucicchio; Matteo Santamaria; Nicola Trevisi; Giuseppe Maccabelli; Francesco Giraldi; Gaetano Fassini; Stefania Riva; Massimo Moltrasio; Manuela Cireddu; Fabrizio Veglia; Paolo Della Bella
• Keywords: Male; Salvage Therapy; Incidence; Middle Aged; Defibrillators, Implantable; 3. Good health; Electrocardiography; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Catheter Ablation; Secondary Prevention; Tachycardia, Ventricular; Humans; Female; Aged; Follow-Up Studies

Electrical storm (ES) caused by recurrent episodes of ventricular tachycardia (VT) can cause sudden death in patients with implantable cardioverter-defibrillators and adversely affects prognosis survivors. Catheter ablation has been proposed for treating ES, but its long-term effect a large population never verified.Ninety-five consecutive coronary artery disease (72 patients), idiopathic dilated cardiomyopathy (10 arrhythmogenic right dysplasia/cardiomyopathy (13 patients) undergoing catheter drug-refractory ES were prospectively evaluated. Short-term efficacy was defined complete protocol programmed electric stimulation in-hospital outcome; analysis addressed recurrence, cardiac mortality, VT recurrence. Pleomorphic/nontolerated VTs required electroanatomic noncontact mapping 48 22 patients, respectively, percutaneous cardiopulmonary support 10 patients. An epicardial approach used After 1 to 3 procedures, induction any clinical VT(s) electrical prevented 85 (89%). acutely suppressed all patients; minimum period 7 days stable rhythm before hospital discharge. At median follow-up months (range, 43 months), 87 (92%) free 63 (66%) Eight persistent inducibility had recurrence; 4 them died suddenly despite appropriate cardioverter-defibrillator intervention. All together, 11 95 (12%) cardiac-related reasons. In the group presenting abolished, no recurrence documented, mortality significantly lower compared showing > or = still inducible after ablation.Advanced strategies applied are effective short-term treatment ES. By preventing may play protective role over long term and, together pharmacological therapy, favorably affect mortality.