Predicting Survival in Ventricular Tachycardia Storm: The CHAMPS Risk Score and Implications for Ablation Timing.

BACKGROUND

Ventricular tachycardia (VT) storm is associated with substantial risk of in-hospital mortality. There are limited data on which patients are at highest risk and the optimal timing of catheter ablation for VT.

OBJECTIVES

This study sought to identify predictors of in-hospital mortality among patients with VT storm, develop a mortality risk score, and evaluate the impact of ablation timing across risk strata.

METHODS

Retrospective analysis of patients admitted with VT storm at 6 high-volume tertiary care centers between 2015 and 2024. Multivariable logistic regression was used to identify independent predictors of acute in-hospital mortality. A weighted clinical risk score-the CHAMPS (cerebrovascular accident, hypoxia, admission diagnosis, malnutrition, vasopressors, sepsis) score-was developed from these predictors. Mortality rates were compared across risk strata and by timing of VT ablation.

RESULTS

A total of 1,675 patients met inclusion criteria and 363 (22%) died during the index hospitalization. Independent predictors of mortality included acute cerebrovascular accident (OR: 3.9), hypoxia resulting in intubation (OR: 3.8), an admission diagnosis other than VT (OR: 4.1), severe malnutrition (OR: 1.4), multiple vasopressor agents (OR: 1.8), and sepsis or fever (OR: 5.0). Using the proportionally weighted CHAMPS score, mortality was 6.6% in low-risk patients, 26.7% in moderate-risk patients, and 60.7% in high-risk patients. VT ablation was performed in 59% of patients and early ablation performed within 7 days of developing VT storm was protective against in hospital mortality (OR: 0.01), independent of CHAMPS score.

CONCLUSIONS

VT storm is associated with high risk of acute in-hospital mortality and the CHAMPS score identifies patients at highest risk. Early catheter ablation is associated with significantly improved survival across risk categories.