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Effect of Catheter Ablation of Electrical Storm on Survival
TAKE-HOME MESSAGE
- This multicenter propensity score–matched analysis involving 576 patients with electrical storm (ES) revealed that catheter ablation significantly reduced ES recurrence at 1 year (5% vs 26%) and improved survival rates at both 1 year (91% vs 81%) and 3 years (78% vs 71%) compared with medical therapy alone. The beneficial effects were consistent across subgroups, including older patients and those with a low LVEF of less than 35%.
- These findings suggest that clinicians managing patients with ES should consider catheter ablation as an early therapeutic strategy, particularly in patients with a reduced LVEF, rather than relying solely on medical therapy. Given the substantial mortality benefit observed across different patient population groups, prospective randomized studies are warranted to confirm these outcomes.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
Electrical storm (ES) is a life-threatening condition, associated with substantial early and subacute mortality. Catheter ablation (CA) is a well-established therapy for ES. However, data regarding the impact of CA on the short-term and midterm survival of patients admitted for ES remain unclear.
OBJECTIVES
This multicenter study aimed to investigate the impact of CA of ES on survival outcomes, while accounting for key patient characteristics associated with treatment selection.
METHODS
A propensity score-matching (PSM) analysis was performed on 780 consecutive patients admitted for ES in 4 tertiary centers. PSM (1:1) based on the main characteristics associated with the use of CA or medical therapy alone was performed, resulting in 2 groups of 288 patients.
RESULTS
After PSM, patients who underwent CA (n = 288) and those treated with medical therapy alone (n = 288) did not present any significant differences in the main demographic characteristics, ES presentation, and management. Compared with medical therapy alone, CA was associated with a significantly lower rate of ES recurrence at 1 year (5% vs 26%; P < 0.001). Similarly, CA was associated with a higher 1-year (91% vs 81%; P < 0.001) and 3-year (78% vs 71%; P = 0.017) survival after discharge. In subgroup analyses, effect of ablation therapy remained consistent in patients older than 70 years of age (HR: 0.39; 95% CI: 0.24-0.66), with substantial efficacy in patients with a LVEF <35% (HR: 0.39; 95% CI: 0.27-0.59).
CONCLUSIONS
In propensity-matched analyses, this large study shows that CA-based management of patients admitted for ES is associated with a reduction in mortality compared with medical treatment, particularly in patients with a low ejection fraction.
Additional Info
Impact of Catheter Ablation of Electrical Storm on Survival: A Propensity Score-Matched Analysis
JACC Clin Electrophysiol 2024 Oct 01;10(10)2117-2128, K Benali, S Ninni, C Guenancia, R Mohammed, D Decaudin, O Bourdrel, A Salaun, C Yvorel, P Groussin, D Pavin, K Vlachos, P Jaïs, JB Bouchet, J Morel, F Brigadeau, G Laurent, D Klug, A Da Costa, M Haissaguerre, R MartinsFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The management of ventricular arrhythmias (VA) with antiarrhythmic drugs was enhanced by the introduction of direct current–based catheter ablation (CA) in 1983.1 With technological advancements, radiofrequency ablation replaced direct current ablation, offering improved safety and efficacy.2 As the understanding of VA evolved, research efforts and treatment guidelines became more refined. The 2017 AHA/ACC/HRS guidelines for managing patients with VAs and preventing sudden cardiac death,3 alongside other studies, identified distinct clinical scenarios such as stable VA versus electrical storm (ES) and specific patient populations, including those with ischemic cardiomyopathy or without structural heart disease (SHD).4,5
In this study, Benali et al examined survival outcomes following CA in patients with ES, comparing them with a propensity score–matched population. Consecutive patients were enrolled from four intensive care units at referral medical centers. Pediatric patients and those without SHD were excluded. A total of 780 patients (288 treated with CA and 492 with medical therapy alone) were matched 1:1 using covariates such as age, sex, LVEF, NYHA class, type of cardiomyopathy, and treatment at admission, achieving effective bias reduction (standardized mean differences, <0.2). CA significantly reduced ES recurrence rates at 1 year (5% vs 26%, P < .001) and improved 1-year (91% vs 81%; P < .001) and 3-year (78% vs 71%; P = .017) survival compared with medical therapy alone. Subgroup analyses revealed that the benefits of CA were most pronounced in patients with reduced LVEF (<35%), with a hazard ratio for 1-year mortality of 0.39 (95% CI, 0.27–0.59). Patients undergoing CA experienced a less than 5% rate of severe complications, and the rate of in-hospital mortality was 57% lower than in those treated with medical therapy alone (7.6% vs 17.7%; P < .001).
By leveraging robust statistical methods and long-term patient-level data from high-volume centers specializing in CA, this study underscores the substantial benefits of CA in managing ES. The findings align with prior studies with more limited designs,2,6-8 reinforcing the role of CA in this patient population. A notable observation is that most cardiac-related deaths during follow-up (65.8%) were due to worsening heart failure rather than persistent ES. This highlights the critical interplay between VA and heart failure mortality and hospitalizations.9,10 Consequently, the management of VA and ES must prioritize a comprehensive approach that addresses both the arrhythmia and the underlying SHD.
References