This Article Full Text Full Text (PDF) All Versions of this Article: 117/4/462    most recent CIRCULATIONAHA.106.686534v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Carbucicchio, C. Articles by Della Bella, P. Search for Related Content PubMed PubMed Citation Articles by Carbucicchio, C. Articles by Della Bella, P. Related Collections Electrophysiology Ablation/ICD/surgery Arrhythmias, clinical electrophysiology, drugs Related Article

(Circulation. 2008;117:462-469.)
© 2008 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Catheter Ablation for the Treatment of Electrical Storm in Patients With Implantable Cardioverter-Defibrillators

Short- and Long-Term Outcomes in a Prospective Single-Center Study

Corrado Carbucicchio, MD; Matteo Santamaria, MD; Nicola Trevisi, MD; Giuseppe Maccabelli, MD; Francesco Giraldi, MD; Gaetano Fassini, MD; Stefania Riva, MD; Massimo Moltrasio, MD; Manuela Cireddu, MD; Fabrizio Veglia, PhD; Paolo Della Bella, MD

From the Arrhythmia Department, Institute of Cardiology, University of Milan, IRCCS–Centro Cardiologico Monzino, Milan, Italy.

Correspondence to Corrado Carbucicchio, Arrhythmia Department, Institute of Cardiology, University of Milan, IRCCS–Centro Cardiologico Monzino, Via Parea, 4, 20138–Milan, Italy. E-mail corrado.carbucicchio{at}ccfm.it

Received December 23, 2006; accepted November 16, 2007.

Background— Electrical storm (ES) caused by recurrent episodes of ventricular tachycardia (VT) can cause sudden death in patients with implantable cardioverter-defibrillators and adversely affects prognosis in survivors. Catheter ablation has been proposed for treating ES, but its long-term effect in a large population has never been verified.

Methods and Results— Ninety-five consecutive patients with coronary artery disease (72 patients), idiopathic dilated cardiomyopathy (10 patients), and arrhythmogenic right ventricular dysplasia/cardiomyopathy (13 patients) undergoing catheter ablation for drug-refractory ES were prospectively evaluated. Short-term efficacy was defined by a complete protocol of programmed electric stimulation and by in-hospital outcome; long-term analysis addressed ES recurrence, cardiac mortality, and VT recurrence. Pleomorphic/nontolerated VTs required electroanatomic and noncontact mapping in 48 and 22 patients, respectively, and percutaneous cardiopulmonary support in 10 patients. An epicardial approach was used in 10 patients. After 1 to 3 procedures, induction of any clinical VT(s) by programmed electrical stimulation was prevented in 85 patients (89%). ES was acutely suppressed in all patients; a minimum period of 7 days with stable rhythm was required before hospital discharge. At a median follow-up of 22 months (range, 1 to 43 months), 87 patients (92%) were free of ES and 63 patients (66%) were free of VT recurrence. Eight of 10 patients with persistent inducibility of clinical VT(s) had ES recurrence; 4 of them died suddenly despite appropriate implantable cardioverter-defibrillator intervention. All together, 11 of 95 patients (12%) died of cardiac-related reasons. In the group of patients presenting with all clinical VTs acutely abolished, no ES recurrence was documented, and cardiac mortality was significantly lower compared with the group of patients showing 1 clinical VT still inducible after catheter ablation.

Conclusions— Advanced strategies of catheter ablation applied to a large population of patients are effective in the short-term treatment of ES. By preventing ES recurrence, catheter ablation may play a protective role over the long term and, together with long-term pharmacological therapy, may favorably affect cardiac mortality.

---

 

CLINICAL PERSPECTIVE

Related Article:

Clinical Summaries
Circulation 2008 117: 453-455. [Extract] [Full Text]

This article has been cited by other articles:

				J. D. Mishkin, S. J. Saxonhouse, G. W. Woo, T. A. Burkart, W. M. Miles, J. B. Conti, R. S. Schofield, S. F. Sears, and J. M. Aranda Jr Appropriate Evaluation and Treatment of Heart Failure Patients After Implantable Cardioverter-Defibrillator Discharge Time to Go Beyond the Initial Shock. J. Am. Coll. Cardiol., November 24, 2009; 54(22): 1993 - 2000. [Abstract] [Full Text] [PDF]

				E. M. Aliot, W. G. Stevenson, J. M. Almendral-Garrote, F. Bogun, C. H. Calkins, E. Delacretaz, P. D. Bella, G. Hindricks, P. Jais, M. E. Josephson, et al. EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: Developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA) Europace, June 1, 2009; 11(6): 771 - 817. [Full Text] [PDF]

				M. Grazi, G. Lauri, C. Carbucicchio, and G. Marenzi Use of Levosimendan for Treatment of Cardiogenic Shock Associated With Electrical Storm Ann Intern Med, May 19, 2009; 150(10): 738 - 740. [Full Text] [PDF]

				W.H. W. Tang and G. S. Francis The Year in Heart Failure J. Am. Coll. Cardiol., November 11, 2008; 52(20): 1671 - 1678. [Full Text] [PDF]

				C. Knackstedt, P. Schauerte, and P. Kirchhof Electro-anatomic mapping systems in arrhythmias Europace, November 1, 2008; 10(suppl_3): iii28 - iii34. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, K. Dickstein, A. Cohen-Solal, G. Filippatos, J. J.V. McMurray, P. Ponikowski, P. A. Poole-Wilson, A. Stromberg, D. J. van Veldhuisen, D. Atar, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM) Eur. Heart J., October 1, 2008; 29(19): 2388 - 2442. [Full Text] [PDF]

				K. Dickstein, A. Cohen-Solal, G. Filippatos, J. J.V. McMurray, P. Ponikowski, P. A. Poole-Wilson, A. Stromberg, D. J. van Veldhuisen, D. Atar, A. W. Hoes, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM) Eur J Heart Fail, October 1, 2008; 10(10): 933 - 989. [Full Text] [PDF]

				F. E. Marchlinski Ventricular Tachycardia Ablation: Moving Beyond Treatment of Last Resort Circ Arrhythm Electrophysiol, August 1, 2008; 1(3): 147 - 149. [Full Text] [PDF]

				F. Sacher, U. B. Tedrow, M. E. Field, J.-M. Raymond, B. A. Koplan, L. M. Epstein, and W. G. Stevenson Ventricular Tachycardia Ablation: Evolution of Patients and Procedures Over 8 Years Circ Arrhythm Electrophysiol, August 1, 2008; 1(3): 153 - 161. [Abstract] [Full Text] [PDF]

				J. L. Sapp Venturing Into the Storm Circulation, January 29, 2008; 117(4): 456 - 457. [Full Text] [PDF]