Catheter Ablation Outcomes in Electrical Storm Versus Non-Electrical Storm Ventricular Tachycardia: A Systematic Review and Meta-Analysis.

BACKGROUND

Electrical storm (ES) is a life-threatening manifestation of ventricular tachycardia (VT) associated with highmorbidity and mortality. Catheter ablation is an established therapy for VT, but the impact of ES on ablation outcomes remains uncertain.

METHODS

We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 to compare VT ablation outcomes in patients with and without ES. PubMed, Cochrane Library, and ScienceDirect were searched from inception through January 2026. Eligible studies were comparative cohorts reporting periprocedural or long-term outcomes. Random-effects models were used to pool odds ratios (ORs), hazard ratios (HRs), and mean differences (MDs), with heterogeneity assessed using the I2 statistic.

RESULTS

Six observational cohort studies including 3531 patients (1183 with ES and 2348 without ES) were included. Acute procedural endpoints, including post-ablation VT non-inducibility and residual inducible VT, were similar between groups. Periprocedural or in-hospital mortality was significantly higher in the ES group (OR 4.71, 95% CI 2.76-8.06), whereas complication rates, procedural duration, radiofrequency ablation time, and need for hemodynamic support did not differ significantly. During follow-up, ES was associated with higher all-cause mortality (OR 1.67, 95% CI 1.19-2.35) and greater VT recurrence in both arm-based (OR 1.45, 95% CI 1.11-1.91) and time-to-event analyses (HR 1.35, 95% CI 1.16-1.57).

CONCLUSIONS

VT ablation showed comparable acute procedural success and procedural safety in patients with and without ES. However, ES was associated with higher early and long-term mortality and greater VT recurrence, supporting its role as a marker of adverse prognosis.