Efficacy of catheter ablation in patients with an electrical storm.

BACKGROUND

Electrical storm (ES) is a life-threatening condition requiring prompt and effective therapy. This may be achieved by the use of catheter ablation.

AIM: To assess safety and efficacy of catheter ablation in patients with ES.

METHODS

We performed 28 ablation procedures from February 2006 to May 2010 due to ES in 24 patients (21 men, 3 women, aged 62.5 ± 7.8 years). Eighteen patients had a history of myocardial infarction, 2 - dilated cardiomyopathy, 2 - hypertrophic cardiomyopathy (one also had myocardial infarction), 1 - spongiform cardiomyopathy, 1 - heart failure after aortic valve replacement and 1 - myocarditis. The mean value of ejection fraction was 27.3 ± 6.5% (15-40%). Procedures were performed using the CARTO system. Two patients after an endocardial map had also epicardial mapping performed and one of these patients underwent epicardial cryoablation. The other one underwent a radiofrequency catheter ablation.

RESULTS

During the follow-up period of 27.8 ± 15.9 months 16 (66%) patients had no ventricular tachycardia (VT)/ventricular fibrillation (VF) episodes. Sporadic VT episodes were observed in 3 patients. Recurrence of ES occurred in 3 (12%) patients and 3 (12%) patients died during the follow-up due to the progression of heart failure.

CONCLUSIONS

1. Ablation of ventricular arrhythmias in the course of ES in patients with organic heart disease is safe and effective, and probably improves their prognosis. 2. After ablation, some patients have adequate interventions of implantable cardioverter-defibrillator due to progression of the disease. 3. The method does not prevent haemodynamic mortality.