Impact of catheter ablation on prognostic outcomes in electrical storm

BACKGROUND: Electrical storm (ES) is associated with high mortality and may lead to worsening of heart failure or repeat ICD therapy deliveries. Catheter ablation of ventricular tachycardia (VT) in ischemic heart disease has proven to be successful in reducing ventricular arrhythmia recurrences. The prognostic impact of ablation on patients with ES needs to be further elucidated. OBJECTIVE: To analyse the impact of catheter ablation on prognostic outcomes in patients with electrical storm. METHODS: A composite study endpoint consisting of all-cause death, implantation of a left ventricular assist device or heart transplantation was in consecutive patients who were admitted for ES therapy to our intensive-care unit from 2016 to 2022. Patients who underwent ablation were compared with propensity score-matched patients who underwent conservative treatment. RESULTS: Propensity-score matching of 155 patients with ES resulted in 51 patients undergoing catheter ablation and 51 patients with conservative therapy only with comparable baseline characteristics. A study endpoint event occurred in 18 patients (35%) in the ablation group and 34 patients (67%) in the conservative group (P = 0.015, Hazard ratio 2.06, 95%-CI 1.14-3.72) after a mean follow-up of 867 ± 697 days. Ablation performed within 10 days after ES onset (P = 0.04) and an increased ejection fraction (LVEF, P = 0.024) were associated with a negative prediction of the occurrence of a primary endpoint by bivariate logistic regression. CONCLUSION: Catheter ablation of ES was associated with a lower likelihood of death from any cause, LVAD implantation or heart transplantation as compared to conservative therapy alone, especially when performed timely after ES onset.