Catheter ablation in the treatment of electrical storm: Integrative review

Leal, Ricardo Teixeira; Monteiro, Gabriel Costa; Júnior, Antônio da Silva Menezes

doi:10.1016/j.ipej.2017.07.012

Cited by 4 publications

(6 citation statements)

References 38 publications

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“…During postprocedural PES in our study, we could not induce the clinical VT, but we could induce nonclinical VTs in 19/110 cases (17%) and did not attempt for further ablation. This is in line with the largest studies that analyzed ES in patients with ICM where no clinical VTs could be induced in 60 to 80%, only nonclinical VTs could be induced in 15 and 25% and in 0-10% the clinical VT could still be induced (12).…”

Section: Discussionsupporting

confidence: 89%

Long-term prognosis of successful left ventricular substrate modification of electrical storm

Margkarian

Bogossian

Bandorski

et al. 2022

Front. Cardiovasc. Med.

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IntroductionThe Electrical storm (ES) subsumes a state of electrical instability of the heart, which manifests itself in repeated and potentially fatal ventricular arrhythmias (VA). We examine the long-term effects of substrate modification with regards to mortality, ventricular tachycardia (VT) recurrences and hospitalization depending on age, gender, heart function, scare location, VT documentation, postprocedural electrical stimulation (PES) and induced VTs.MethodsFrom 08/2008 and 09/2019 160 consecutive patients admitted for ES ablation via electroanatomical mapping were followed up until 04/2021.Results50/160 patients showed VT recurrences after 13.8 ± 21.7 (0.0–80.3) months, with a characteristic steep curve directly after ES and then a rapid decline leading to a plateau (first month 10/50 (20%), first year 35/50 VT recurrences (70%) Mortality rates followed a similar pattern also the initial decline was not as steep. 42 patients died during the observation period (26%) after 16.6 ± 16.1 (0.0-67.9) months after ablation day (first month (n = 7, 16.7%) first year (n = 21, 50%). Gender, age, scare localization, missing VT documentation did not worsen outcome. Induction of >3 VTs and lack of PES due to hemodynamic instability significantly decreased effectiveness. Finding the entry significantly increased long-term effects.ConclusionAblation of ES is safe and feasible independent of a variety of factors. Employing more sophisticated tools to understand the reentry mechanism will further improve the long-term outcome.

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Section: Discussionsupporting

confidence: 89%

Long-term prognosis of successful left ventricular substrate modification of electrical storm

Margkarian

Bogossian

Bandorski

et al. 2022

Front. Cardiovasc. Med.

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“…Fortunately, this fatal complication is very rare, as documented in other studies [ 27 , 28 ]. Regarding the short-term results of the RFA, it has been reported in patients with ICM that complete RFA success was achieved in 60–80% of patients, partial success in 15–25%, and failure was reported in 0–10% of patients [ 29 ]. As the majority of our study group participants were patients with ICM, we obtained similar results (77.4%, 19.4%, and 9.68%, respectively).…”

Section: Discussionmentioning

confidence: 99%

Clinical and Laboratory Predictors of Long-Term Outcomes after Catheter Ablation for a Ventricular Electrical Storm

Sławiński,

Hawryszko,

Dyda-Kristowska

et al. 2024

Journal of Interventional Cardiology

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Background. Ventricular electrical storm (VES) is characterized by the occurrence of multiple episodes of sustained ventricular arrhythmias (VA) over a short period of time. Radiofrequency ablation (RFA) has been reported as an effective treatment in patients with ventricular tachycardia (VT). Objective. The aim of the present study was to indicate the short-term and long-term predictors of recurrent VA after RFA was performed due to VES. Methods. A retrospective, single-centre study included patients, who had undergone RFA due to VT between 2012 and 2021. In terms of the short-term (at the end of RFA) effectiveness of RFA, the following scenarios were distinguished: complete success: inability to induce any VT; partial success: absence of clinical VT; failure: inducible clinical VT. In terms of the long-term (12 months) effectiveness of RFA, the following scenarios were distinguished: effective ablation: no recurrence of any VT; partially successful ablation: VT recurrence; ineffective ablation: VES recurrence. Results. The study included 62 patients. Complete short-term RFA success was obtained in 77.4% of patients. The estimated cumulative VT-free survival and VES-free survival were, respectively, 28% and 33% at the 12-month follow-up. Ischemic cardiomyopathy and complete short-term RFA success were predictors of long-term RFA efficacy. Neutrophil to lymphocyte ratio (NLR) and GFR <60 mL/min/1.73 m2 were associated with VES recurrence. NLR ≥2.95 predicted VT and/or VES recurrence with a sensitivity of 66.7% and specificity of 72.2%. Conclusion. Ischemic cardiomyopathy and short-term complete success of RFA were predictors of no VES recurrence during the 12-month follow-up, while NLR and GFR <60 ml/min/1.73 m2 were associated with VES relapse.

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“…In selected cases, acute autonomic modulation under deep sedation was performed to decrease sympathetic tone using stellate ganglion blockade or cervicothoracic epidural blockade 15,16 . The decision to perform an electrophysiologic study (EPS) and catheter ablation was made by the clinical arrhythmology specialist team on a case‐by‐case scenario when VA‐ECMO weaning was precluded by persistent ES 17,18 . Patients with multiple arrhythmic foci, LV thrombus, or clinical evidence of hypoxic–ischaemic encephalopathy were not considered eligible for EPS.…”

Section: Methodsmentioning

confidence: 99%

ECMO for drug‐refractory electrical storm without a reversible trigger: a retrospective multicentric observational study

Durães‐Campos,

Costa,

Ferreira

et al. 2024

ESC Heart Failure

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AimsDrug‐refractory electrical storm (ES) is a life‐threatening medical emergency. We describe the use of venoarterial extracorporeal membrane oxygenation (VA‐ECMO) in drug‐refractory ES without a reversible trigger, for which specific guideline recommendations are still lacking.Methods and resultsRetrospective observational study in four Iberian centres on the indications, treatment, complications, and outcome of drug‐refractory ES not associated with acute coronary syndromes, decompensated heart failure, drug toxicity, electrolyte disturbances, endocrine emergencies, concomitant acute illness with fever, or poor compliance with anti‐arrhythmic drugs, requiring VA‐ECMO for circulatory support. Thirty‐four (6%) out of 552 patients with VA‐ECMO for cardiogenic shock were included [71% men; 57 (44–62) years], 65% underwent cardiopulmonary resuscitation before VA‐ECMO implantation, and 26% during cannulation. Left ventricular unloading during VA‐ECMO was used in 8 (24%) patients: 3 (9%) with intraaortic balloon pump, 3 (9%) with LV vent, and 2 (6%) with Impella. Thirty (88%) had structural heart disease and 8 (24%) had an implantable cardioverter‐defibrillator. The drug‐refractory ES was mostly due to monomorphic ventricular tachycardia (VT) and ventricular fibrillation (VF) (59%), isolated monomorphic VT (26%), polymorphic VT (9%), or VF (6%). Thirty‐one (91%) required deep sedation, 44% overdrive pacing, 36% catheter ablation, and 26% acute autonomic modulation. The main complications were nosocomial infection (47%), bleeding (24%), and limb ischaemia (21%). Eighteen (53%) were weaned from VA‐ECMO, and 29% had heart transplantation. Twenty‐seven (79%) survived to hospital discharge (48 (33–82) days). Non‐survivors were older [62 (58–67) vs. 54 (43–58); P < 0.01] and had a higher first rhythm disorder‐to‐ECMO interval [0 (0–2) vs. 2 (1‐11) days; P = 0.02]. Seven (20%) had rehospitalization during follow‐up [29 (12–48) months], with ES recurrence in 6%.ConclusionsVA‐ECMO bridged drug‐refractory ES without a reversible trigger with a high success rate. This required prolonged hospital stays and coordination between the ECMO centre, the electrophysiology laboratory, and the heart transplant programme.

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Catheter ablation in the treatment of electrical storm: Integrative review

Cited by 4 publications

References 38 publications

Long-term prognosis of successful left ventricular substrate modification of electrical storm

Long-term prognosis of successful left ventricular substrate modification of electrical storm

Clinical and Laboratory Predictors of Long-Term Outcomes after Catheter Ablation for a Ventricular Electrical Storm

ECMO for drug‐refractory electrical storm without a reversible trigger: a retrospective multicentric observational study

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