Successful ventricular tachycardia ablation in patients with electrical storm reduces recurrences and improves survival

Pasquale Vergara, Roderick Tung, Marmar Vaseghi, Chiara Brombin, David Frankel, Luigi Di Biase, Koichi Nagashima, Usha Tedrow, Wendy S. Tzou, William H. Sauer, Nilesh Mathuria, Shiro Nakahara, Kairav Vakil, Venkat Tholakanahalli, T. Jared Bunch, J. Peter Weiss, Timm Dickfeld, Rama Vunnam, Dhanunjaya Lakireddy, J. David BurkhardtAnna Correra, Pasquale Santangeli, David Callans, Andrea Natale, Francis Marchlinski, William G. Stevenson, Kalyanam Shivkumar, Paolo Della Bella

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objective: The purpose of this study was to evaluate the characteristics and outcome of patients undergoing ablation after electrical storm (ES). Methods: Clinical and procedural characteristics, ventricular tachycardia (VT) recurrence, and mortality rates from 1940 patients undergoing VT ablation were compared between patients with and without ES. Results: The group of 677 patients with ES (34.9%) were older, were more frequently men, and had a lower ejection fraction, more advanced heart failure, and a higher prevalence of cardiovascular comorbidities as compared with those without ES (86.1% patients with ES had ≥2 comorbidities vs 71.4%; P <.001). Patients with ES had more inducible VTs (2.5 ± 1.8 vs 1.9 ± 1.9; P <.001), required longer procedures (296.1 ± 119.1 minutes vs 265.7 ± 110.3 minutes; P <.001), and had a higher in-hospital mortality (42 deaths [6.2%] vs 18 deaths [1.4%]; P <.001). At 1-year follow-up, patients with ES experienced a higher risk of VT recurrence and mortality (32.1% vs 22.6% and 20.1% vs 8.5%; long-rank, P <.001 for both). Among patients with ES, those without any inducible VT after ablation had a higher survival rate (86.3%) than did those with nonclinical VTs only (72.9%), those with clinical VTs inducible at programmed electrical stimulation (51.2%), and not-tested patients (65.0%) (long-rank, P <.001 for all). In multivariate analysis, ES remained an independent predictor of in-hospital mortality, VT recurrence, and 1-year mortality (P <.001). Conclusion: Patients with ES have a high risk of VT recurrence and mortality. Patient and procedure characteristics are consistent with advanced cardiac disease and longer and more complex procedures. In patients with ES, acute procedural success is associated with a significant reduction in VT recurrence and improved 1-year survival.

Original languageEnglish (US)
Pages (from-to)48-55
Number of pages8
JournalHeart Rhythm
Volume15
Issue number1
DOIs
StatePublished - Jan 2018

Fingerprint

Ventricular Tachycardia
Recurrence
Survival
Mortality
Hospital Mortality
Comorbidity
Electric Stimulation
Heart Diseases
Multivariate Analysis
Survival Rate
Heart Failure

Keywords

  • Catheter ablation
  • Electrical storm
  • Ischemic cardiomyopathy
  • Nonischemic cardiomyopathy
  • Ventricular tachycardia

Cite this

Vergara, P., Tung, R., Vaseghi, M., Brombin, C., Frankel, D., Di Biase, L., ... Della Bella, P. (2018). Successful ventricular tachycardia ablation in patients with electrical storm reduces recurrences and improves survival. Heart Rhythm, 15(1), 48-55. https://doi.org/10.1016/j.hrthm.2017.08.022

Successful ventricular tachycardia ablation in patients with electrical storm reduces recurrences and improves survival. / Vergara, Pasquale; Tung, Roderick; Vaseghi, Marmar; Brombin, Chiara; Frankel, David; Di Biase, Luigi; Nagashima, Koichi; Tedrow, Usha; Tzou, Wendy S.; Sauer, William H.; Mathuria, Nilesh; Nakahara, Shiro; Vakil, Kairav; Tholakanahalli, Venkat; Bunch, T. Jared; Weiss, J. Peter; Dickfeld, Timm; Vunnam, Rama; Lakireddy, Dhanunjaya; Burkhardt, J. David; Correra, Anna; Santangeli, Pasquale; Callans, David; Natale, Andrea; Marchlinski, Francis; Stevenson, William G.; Shivkumar, Kalyanam; Della Bella, Paolo.

In: Heart Rhythm, Vol. 15, No. 1, 01.2018, p. 48-55.

Research output: Contribution to journalArticle

Vergara, P, Tung, R, Vaseghi, M, Brombin, C, Frankel, D, Di Biase, L, Nagashima, K, Tedrow, U, Tzou, WS, Sauer, WH, Mathuria, N, Nakahara, S, Vakil, K, Tholakanahalli, V, Bunch, TJ, Weiss, JP, Dickfeld, T, Vunnam, R, Lakireddy, D, Burkhardt, JD, Correra, A, Santangeli, P, Callans, D, Natale, A, Marchlinski, F, Stevenson, WG, Shivkumar, K & Della Bella, P 2018, 'Successful ventricular tachycardia ablation in patients with electrical storm reduces recurrences and improves survival', Heart Rhythm, vol. 15, no. 1, pp. 48-55. https://doi.org/10.1016/j.hrthm.2017.08.022
Vergara, Pasquale ; Tung, Roderick ; Vaseghi, Marmar ; Brombin, Chiara ; Frankel, David ; Di Biase, Luigi ; Nagashima, Koichi ; Tedrow, Usha ; Tzou, Wendy S. ; Sauer, William H. ; Mathuria, Nilesh ; Nakahara, Shiro ; Vakil, Kairav ; Tholakanahalli, Venkat ; Bunch, T. Jared ; Weiss, J. Peter ; Dickfeld, Timm ; Vunnam, Rama ; Lakireddy, Dhanunjaya ; Burkhardt, J. David ; Correra, Anna ; Santangeli, Pasquale ; Callans, David ; Natale, Andrea ; Marchlinski, Francis ; Stevenson, William G. ; Shivkumar, Kalyanam ; Della Bella, Paolo. / Successful ventricular tachycardia ablation in patients with electrical storm reduces recurrences and improves survival. In: Heart Rhythm. 2018 ; Vol. 15, No. 1. pp. 48-55.
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abstract = "Objective: The purpose of this study was to evaluate the characteristics and outcome of patients undergoing ablation after electrical storm (ES). Methods: Clinical and procedural characteristics, ventricular tachycardia (VT) recurrence, and mortality rates from 1940 patients undergoing VT ablation were compared between patients with and without ES. Results: The group of 677 patients with ES (34.9{\%}) were older, were more frequently men, and had a lower ejection fraction, more advanced heart failure, and a higher prevalence of cardiovascular comorbidities as compared with those without ES (86.1{\%} patients with ES had ≥2 comorbidities vs 71.4{\%}; P <.001). Patients with ES had more inducible VTs (2.5 ± 1.8 vs 1.9 ± 1.9; P <.001), required longer procedures (296.1 ± 119.1 minutes vs 265.7 ± 110.3 minutes; P <.001), and had a higher in-hospital mortality (42 deaths [6.2{\%}] vs 18 deaths [1.4{\%}]; P <.001). At 1-year follow-up, patients with ES experienced a higher risk of VT recurrence and mortality (32.1{\%} vs 22.6{\%} and 20.1{\%} vs 8.5{\%}; long-rank, P <.001 for both). Among patients with ES, those without any inducible VT after ablation had a higher survival rate (86.3{\%}) than did those with nonclinical VTs only (72.9{\%}), those with clinical VTs inducible at programmed electrical stimulation (51.2{\%}), and not-tested patients (65.0{\%}) (long-rank, P <.001 for all). In multivariate analysis, ES remained an independent predictor of in-hospital mortality, VT recurrence, and 1-year mortality (P <.001). Conclusion: Patients with ES have a high risk of VT recurrence and mortality. Patient and procedure characteristics are consistent with advanced cardiac disease and longer and more complex procedures. In patients with ES, acute procedural success is associated with a significant reduction in VT recurrence and improved 1-year survival.",
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T1 - Successful ventricular tachycardia ablation in patients with electrical storm reduces recurrences and improves survival

AU - Vergara, Pasquale

AU - Tung, Roderick

AU - Vaseghi, Marmar

AU - Brombin, Chiara

AU - Frankel, David

AU - Di Biase, Luigi

AU - Nagashima, Koichi

AU - Tedrow, Usha

AU - Tzou, Wendy S.

AU - Sauer, William H.

AU - Mathuria, Nilesh

AU - Nakahara, Shiro

AU - Vakil, Kairav

AU - Tholakanahalli, Venkat

AU - Bunch, T. Jared

AU - Weiss, J. Peter

AU - Dickfeld, Timm

AU - Vunnam, Rama

AU - Lakireddy, Dhanunjaya

AU - Burkhardt, J. David

AU - Correra, Anna

AU - Santangeli, Pasquale

AU - Callans, David

AU - Natale, Andrea

AU - Marchlinski, Francis

AU - Stevenson, William G.

AU - Shivkumar, Kalyanam

AU - Della Bella, Paolo

PY - 2018/1

Y1 - 2018/1

N2 - Objective: The purpose of this study was to evaluate the characteristics and outcome of patients undergoing ablation after electrical storm (ES). Methods: Clinical and procedural characteristics, ventricular tachycardia (VT) recurrence, and mortality rates from 1940 patients undergoing VT ablation were compared between patients with and without ES. Results: The group of 677 patients with ES (34.9%) were older, were more frequently men, and had a lower ejection fraction, more advanced heart failure, and a higher prevalence of cardiovascular comorbidities as compared with those without ES (86.1% patients with ES had ≥2 comorbidities vs 71.4%; P <.001). Patients with ES had more inducible VTs (2.5 ± 1.8 vs 1.9 ± 1.9; P <.001), required longer procedures (296.1 ± 119.1 minutes vs 265.7 ± 110.3 minutes; P <.001), and had a higher in-hospital mortality (42 deaths [6.2%] vs 18 deaths [1.4%]; P <.001). At 1-year follow-up, patients with ES experienced a higher risk of VT recurrence and mortality (32.1% vs 22.6% and 20.1% vs 8.5%; long-rank, P <.001 for both). Among patients with ES, those without any inducible VT after ablation had a higher survival rate (86.3%) than did those with nonclinical VTs only (72.9%), those with clinical VTs inducible at programmed electrical stimulation (51.2%), and not-tested patients (65.0%) (long-rank, P <.001 for all). In multivariate analysis, ES remained an independent predictor of in-hospital mortality, VT recurrence, and 1-year mortality (P <.001). Conclusion: Patients with ES have a high risk of VT recurrence and mortality. Patient and procedure characteristics are consistent with advanced cardiac disease and longer and more complex procedures. In patients with ES, acute procedural success is associated with a significant reduction in VT recurrence and improved 1-year survival.

AB - Objective: The purpose of this study was to evaluate the characteristics and outcome of patients undergoing ablation after electrical storm (ES). Methods: Clinical and procedural characteristics, ventricular tachycardia (VT) recurrence, and mortality rates from 1940 patients undergoing VT ablation were compared between patients with and without ES. Results: The group of 677 patients with ES (34.9%) were older, were more frequently men, and had a lower ejection fraction, more advanced heart failure, and a higher prevalence of cardiovascular comorbidities as compared with those without ES (86.1% patients with ES had ≥2 comorbidities vs 71.4%; P <.001). Patients with ES had more inducible VTs (2.5 ± 1.8 vs 1.9 ± 1.9; P <.001), required longer procedures (296.1 ± 119.1 minutes vs 265.7 ± 110.3 minutes; P <.001), and had a higher in-hospital mortality (42 deaths [6.2%] vs 18 deaths [1.4%]; P <.001). At 1-year follow-up, patients with ES experienced a higher risk of VT recurrence and mortality (32.1% vs 22.6% and 20.1% vs 8.5%; long-rank, P <.001 for both). Among patients with ES, those without any inducible VT after ablation had a higher survival rate (86.3%) than did those with nonclinical VTs only (72.9%), those with clinical VTs inducible at programmed electrical stimulation (51.2%), and not-tested patients (65.0%) (long-rank, P <.001 for all). In multivariate analysis, ES remained an independent predictor of in-hospital mortality, VT recurrence, and 1-year mortality (P <.001). Conclusion: Patients with ES have a high risk of VT recurrence and mortality. Patient and procedure characteristics are consistent with advanced cardiac disease and longer and more complex procedures. In patients with ES, acute procedural success is associated with a significant reduction in VT recurrence and improved 1-year survival.

KW - Catheter ablation

KW - Electrical storm

KW - Ischemic cardiomyopathy

KW - Nonischemic cardiomyopathy

KW - Ventricular tachycardia

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