Ischemic or Coronary Evaluations in Patients With Monomorphic VT Electrical Storm Undergoing VT Ablation

Feras Alkhalaileh; Oussama M Wazni; Alan Kiang; Joshua Parker; Stephen Ellis; Mohamed Kanj; Medhat Farwati; Venugopal Menon; Thomas Callahan; Bryan Baranowski; Shady Nakhla; Tyler Taigen; Pasquale Santangeli; Tariq Kewan; Daniel Cantillon; Jakub Sroubek; John Rickard; Mohammad Zmaili; Mandeep Bhargava; Walid I Saliba; Hiroshi Nakagawa; Ayman A Hussein

doi:10.1016/j.jacep.2023.04.030

Ischemic or Coronary Evaluations in Patients With Monomorphic VT Electrical Storm Undergoing VT Ablation

JACC Clin Electrophysiol. 2023 Sep;9(9):1890-1899. doi: 10.1016/j.jacep.2023.04.030. Epub 2023 Aug 2.

Authors

Feras Alkhalaileh¹, Oussama M Wazni¹, Alan Kiang¹, Joshua Parker¹, Stephen Ellis¹, Mohamed Kanj¹, Medhat Farwati¹, Venugopal Menon¹, Thomas Callahan¹, Bryan Baranowski¹, Shady Nakhla¹, Tyler Taigen¹, Pasquale Santangeli¹, Tariq Kewan¹, Daniel Cantillon¹, Jakub Sroubek¹, John Rickard¹, Mohammad Zmaili¹, Mandeep Bhargava¹, Walid I Saliba¹, Hiroshi Nakagawa¹, Ayman A Hussein²

Affiliations

¹ Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
² Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA. Electronic address: husseia@ccf.org.

PMID: 37542488
DOI: 10.1016/j.jacep.2023.04.030

Abstract

Background: Monomorphic ventricular tachycardia (VT) electrical storm (ES) in patients with coronary artery disease is dependent on scarred myocardium. The role of routine ischemic or coronary evaluations before ablation in patients presenting with monomorphic VT storm, without acute coronary syndrome (ACS), remains unknown.

Objectives: This study sought to assess the impact of ischemic or coronary evaluations on procedural outcomes and post-ablation mortality in monomorphic VT storm patients.

Methods: All patients undergoing VT ablation at the Cleveland Clinic from 2014 to 2020 after presenting with monomorphic VT storm were enrolled in a prospectively maintained registry. The associations among ischemic or coronary evaluations and short-term procedural efficacy, acute outcomes, and mortality during follow-up were assessed.

Results: A total of 97 consecutive patients with monomorphic VT storm in the absence of ACS underwent VT ablations. This cohort was characterized by severe LV systolic dysfunction (mean left ventricular ejection fraction 30.3%, 67% with known ischemic cardiomyopathy) with moderately severe heart failure (median NYHA functional class II); 45% of patients underwent ischemic or coronary evaluations via coronary angiography (10%), noninvasive myocardial perfusion (26%), or both (9%). The yield of these evaluations was low: No acute coronary occlusions were identified. There was no association between ischemic evaluation and acute ablation outcomes or mortality during follow-up. Similarly, in a secondary analysis, the yield of ischemic or coronary evaluations in patients with monomorphic VT storm and known coronary disease (regardless of ablation status) was found to be low.

Conclusions: Ischemic evaluations in patients with monomorphic VT storm without ACS may not improve procedural outcomes or mortality after ablation.

Keywords: coronary angiography; electrical storm; implantable cardioverter-defibrillator; ischemic evaluation; structural heart disease; ventricular tachycardia.

MeSH terms

Acute Coronary Syndrome* / complications
Catheter Ablation* / adverse effects
Humans
Myocardial Ischemia* / complications
Myocardial Ischemia* / surgery
Stroke Volume
Tachycardia, Ventricular*
Treatment Outcome
Ventricular Function, Left