AIMS: To investigate predictors of long-term outcomes after catheter ablation (CA) for ventricular tachycardia (VT) and the impact of electrical storm (ES) prior to index ablation procedures. METHODS: We studied consecutive patients with structural heart disease and VT (n = 328; age: 63±12 years; 88% males; 72% ischaemic cardiomyopathy; LVEF: 32±12%) who had undergone CA. According to presenting arrhythmia at baseline, they were divided into ES (n = 93, 28%) and non-ES groups. Clinical predictors of all-cause mortality were investigated and a clinically useful risk score (SCORE) was constructed. RESULTS: During a median follow-up of 927 days (IQR: 564-1626), 67% vs. 60% of patients (p = 0.05) experienced VT recurrence in the ES vs. the non-ES group, respectively; and 41% vs. 32% patients died (p = 0.02), respectively. Five factors were independently associated with mortality: age >70 years (hazard ratio (HR): 1.6, 95% confidence interval (CI): 1.1-2.4, p = 0.01), NYHA class ≥3 (HR: 1.9, 95% CI: 1.2-2.9, p = 0.005), a serum creatinine level >1.3 mg/dL (HR: 1.6, 95% CI: 1.1-2.3, p = 0.02), LVEF ≤25% (HR: 2.4, 95% CI: 1.6-3.5, p = 0.00004), and amiodarone therapy (HR: 1.5, 95% CI: 1.0-2.2, p = 0.03). A risk SCORE ranging from 0-4 (1 point for either high-risk age, NYHA, creatinine, or LVEF) correlated with mortality. ES during index ablation independently predicted mortality only in patients with a SCORE ≤1. CONCLUSIONS: Advanced LV dysfunction, older age, higher NYHA class, renal dysfunction, and amiodarone therapy, but not ES, were predictors of poor outcomes after CA for VT in the total population. However, ES did predict mortality in a low-risk sub-group of patients.

Department of Cardiology Institute for Clinical and Experimental Medicine IKEM Prague Czech Republic

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Exner DV, Klein GJ, Prystowsky EN. Primary prevention of sudden death with implantable defibrillator therapy in patients with cardiac disease: Can we afford to do it? (Can we afford not to?). PubMed

Calkins H, Epstein A, Packer D, Arria AM, Hummel J, Gilligan DM, et al. Catheter ablation of ventricular tachycardia in patients with structural heart disease using cooled radiofrequency energy: results of a prospective multicenter study. PubMed

Carbucicchio C, Santamaria M, Trevisi N, Maccabelli G, Giraldi F, Fassini G, et al. Catheter ablation for the treatment of electrical storm in patients with implantable cardioverter-defibrillators: Short- and long-term outcomes in a prospective single-center study. PubMed DOI

Kozeluhova M, Peichl P, Cihak R, Wichterle D, Vancura V, Bytesnik J, et al. Catheter ablation of electrical storm in patients with structural heart disease. PubMed DOI

Guerra F, Shkoza M, Scappini L, Flori M, Capucci A. Role of electrical storm as a mortality and morbidity risk factor and its clinical predictors: a meta-analysis. PubMed DOI

Deneke T, Shin DI, Lawo T, Bosche L, Balta O, Anders H, et al. Catheter ablation of electrical storm in a collaborative hospital network. PubMed DOI

Tanner H, Hindricks G, Volkmer M, Furniss S, Kuhlkamp V, Lacroix D, et al. Catheter ablation of recurrent scar-related ventricular tachycardia using electroanatomical mapping and irrigated ablation technology: results of the prospective multicenter EURO-VTstudy. PubMed DOI

Bansch D, Bocker D, Brunn J, Weber M, Breithardt G, Block M. Clusters of ventricular tachycardias signify impaired survival in patients with idiopathic dilated cardiomyopathy and implantable cardioverter defibrillators. PubMed

Peichl P, Wichterle D, Pavlu L, Cihak R, Aldhoon B, Kautzner J. Complications of catheter ablation of ventricular tachycardia: A single-center experience. PubMed DOI

Brigadeau F, Kouakam C, Klug D, Marquie C, Duhamel A, Mizon-Gerard F, et al. Clinical predictors and prognostic significance of electrical storm in patients with implantable cardioverter defibrillators. PubMed DOI

Gatzoulis KA, Andrikopoulos GK, Apostolopoulos T, Sotiropoulos E, Zervopoulos G, Antoniou J, et al. Electrical storm is an independent predictor of adverse long-term outcome in the era of implantable defibrillator therapy. PubMed DOI

Sesselberg HW, Moss AJ, McNitt S, Zareba W, Daubert JP, Andrews ML, et al. Ventricular arrhythmia storms in postinfarction patients with implantable defibrillators for primary prevention indications: A MADIT-II substudy. PubMed DOI

Kuck K-H, Schaumann A, Eckardt L, Willems S, Ventura R, Delacrétaz E, et al. Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): A multicentre randomised controlled trial. PubMed

Reddy VY, Reynolds MR, Neuzil P, Richardson AW, Taborsky M, Jongnarangsin K, et al. Prophylactic catheter ablation for the prevention of defibrillator therapy. PubMed DOI PMC

Hayashi T, Fukamizu S, Hojo R, Komiyama K, Tanabe Y, Tejima T, et al. Prophylactic catheter ablation for induced monomorphic ventricular tachycardia in patients with implantable cardioverter defibrillators as primary prevention. PubMed DOI

Della Bella P, Baratto F, Tsiachris D, Trevisi N, Vergara P, Bisceglia C, et al. Management of ventricular tachycardia in the setting of a dedicated unit for the treatment of complex ventricular arrhythmias: Long-term outcome after ablation. PubMed DOI

Ghanbari H, Baser K, Yokokawa M, Stevenson W, Della Bella P, Vergara P, et al. Noninducibility in postinfarction ventricular tachycardia as an end point for ventricular tachycardia ablation and its effects on outcomes: a meta-analysis. PubMed DOI

Dinov B, Fiedler L, Schönbauer R, Bollmann A, Rolf S, Piorkowski C, et al. Outcomes in catheter ablation of ventricular tachycardia in dilated nonischemic cardiomyopathy compared with ischemic cardiomyopathy: results from the prospective heart centre of Leipzig VT (HELP-VT) study. PubMed DOI

Piers SR, Leong DP, van Huls van Taxis CF, Tayyebi M, Trines SA, Pijnappels DA, et al. Outcome of ventricular tachycardia ablation in patients with nonischemic cardiomyopathy: the impact of noninducibility. PubMed DOI

Dinov B, Arya A, Schratter A, Schirripa V, Fiedler L, Sommer P, et al. Catheter ablation of ventricular tachycardia and mortality in patients with nonischemic dilated cardiomyopathy: can noninducibility after ablation be a predictor for reduced mortality? PubMed DOI

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