The impact of previous VT substrate radiofrequency catheter ablation procedures for patients presenting with electrical storm
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Ventricular tachycardias (VT) that appear after catheter ablation (RFA) may respond poorly to conservative treatment and increase mortality. Current evidence favors repeating RFA to reduce VT-burden and improve outcomes if recurrences are precluded. This has not exclusively been studied in electrical storm patients. AIMS: We sought to compare patient/procedural characteristics and long-term all-cause mortality and recurrences in single-RFA versus repeat-RFA patients. MATERIAL AND METHODS: This was a retrospective single-center analysis of consecutive electrical storm patients treated by RFA monitored for a mean of 32.8 (range 10-68) months. Inducibility of sustained monomorphic VT was assessed by programmed ventricular stimulation. We assessed differences in patient/procedural characteristics and compared all-cause mortality and recurrences in single-RFA versus repeat-RFA during the first year post-ablation. RESULTS: In total, 101 patients (mean age 59.69 [12.8] years, 32.7% non-ischemic cardiomyopathies, 34 cases of repeat-RFA) were included. Compared to single-RFA, repeat-RFA patients more frequently had non-ischemic cardiomyopathies (47.1% vs. 26.9%; P = 0.04), required more epicardial ablation (32.4% vs. 14.9%; P = 0.04), and more frequently had epicardial-access complications (14.8% vs. 1.6%; P = 0.02). All-cause mortality (repeat-RFA 10 deaths [29.4%] vs. single-RFA 21 deaths [31.3%]; P = 0.99) and recurrences (repeat-RFA 13 recurrences [38.2%] vs. single-RFA 23 recurrences [34.3%]; P = 0.82) were comparable during follow-up. All-cause mortality (log rank P = 0.62) and recurrences (log-rank P = 0.65) were similar in repeat-RFA vs. single-RFA during the first year after ablation. CONCLUSIONS: Despite requiring more epicardial ablation and more non-ischemic myocardial substrate, repeat-RFA patients showed similar all-cause mortality and recurrences compared to single-RFA during the first year post-ablation.
Source: Kardiologia Polska
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4408656063