Radiofrequency Catheter Ablation for Arrhythmic Storm in Patients with An Implantable Cardioverter Defibrillator

Abstract

The aim of the study was to analyze the usefulness of RFA in controlling arrhythmic storm due to hemodynamically stable VT in a cohort of patients with an ICD and to evaluate the incidence of arrhythmic storm among patients with an ICD. A group of 13 (3%) of 403 consecutive ICD recipients were submitted to RFA of VT during an arrhythmic storm. Two additional patients were referred from other institutions. Standard criteria were used for VT endocardial ablation. A transcatheter epicardial approach was required in three patients. A total of 18 procedures were performed in 15 patients. A mean of 13.2 +/- 9.7 pulses of RF were delivered. Clinical tachycardia was successfully ablated in 12 (80%) patients. One patient died in incessant VT, 1 patient underwent heart transplant, and 1 was treated with direct current ablation. During a mean follow-up of 12 +/- 17 months, only two patients suffered a single episode of VT. Arrhythmic storm requiring VT ablation was uncommon among patients with an ICD and occurred late after ICD implantation. The arrhythmic episode was successfully controlled in the majority of patients with endocardial or epicardial RFA.

Electrical storm in patients with implantable cardioverter-defibrillator in the era of catheter ablation: Implications for better rhythm control

“…Sra 21 Two further cohort studies of catheter ablation for ES also showed high acute success rate and significant survival benefit. 22,23 In agreement with these data, we found that ES ablation has an acute and long-term success of 92%. Moreover, despite the fact that mortality of ES patients is increased; there is a tendency of reduced mortality when ablated patients are compared to a conservative therapy.…”

Clinical spectrum of patients with a Brugada ECG

“…Additionally, oral quinidine therapy can be used if arrhythmia is persistent [76]. In the rare case of failure of these therapeutic options, radiofrequency-catheter ablation of the ventricular ectopic foci can be attempted, but should be regarded as a highly specialized modality [77,78]. Though exceedingly rare, patients with BrS suffering from recurrent arrhythmic storm, refractory to all other treatment, should be considered candidates for cardiac transplantation.…”

The Brugada syndrome

“…Additionally, oral quinidine therapy can be started if arrhythmic storms cannot be controlled [73]. In case of failure of these therapeutic options, radiofrequency-catheter ablation of the triggering ventricular ectopies can be attempted, but should be regarded as a highly specialized 'ultimate stage' treatment [74,75]. In very rare cases, BrS patients suffering from recurrent arrhythmic storms, refractory to any other treatment, should be considered candidates for cardiac transplantation.…”