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

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.

Keywords: Catheter ablation; Electrical storm; Implantable cardioverter defibrillator.