Beyond the Storm

Comparison of Clinical Factors, Arrhythmogenic Substrate, and Catheter Ablation Outcomes in Structural Heart Disease Patients With versus Those Without a History of Ventricular Tachycardia Storm

Saurabh Kumar, Akira Fujii, Sunil Kapur, Jorge E. Romero, Nishaki K. Mehta, Shinichi Tanigawa, Laurence M. Epstein, Bruce A. Koplan, Gregory F. Michaud, Roy M. John, William G. Stevenson, Usha B. Tedrow

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Aims: Catheter ablation can be lifesaving in ventricular tachycardia (VT) storm, but the underlying substrate in patients with storm is not well characterized. We sought to compare the clinical factors, substrate, and outcomes differences in patients with sustained monomorphic VT who present for catheter ablation with VT storm versus those with a nonstorm presentation. Methods: Consecutive ischemic (ICM; n = 554) or nonischemic cardiomyopathy patients (NICM; n = 369) with a storm versus nonstorm presentation were studied (ICM storm 186; NICM storm 101). Results: In ICM, storm compared with nonstorm patients had significantly lower left ventricular (LV) ejection fraction (EF), greater number of antiarrhythmic drug (AAD) failures, slower VTs, greater number of scarred LV segments, higher incidence of anterior, septal, and apical endocardial LV scar (all P < 0.05). However, outcomes in follow-up were similar (12-month ventricular arrhythmia [VA]-free survival: 51% vs. 52%, P = 0.6; survival free of death/transplant 75% vs. 87%, P = 0.7). In addition to the above differences, NICM storm patients were also older; however, the extent and distribution of scar was similar except for a higher incidence of lateral endocardial scar in storm patients (P = 0.05). VA-free survival (36% vs. 47%, P = 0.004) and survival free of death/transplant, however, were worse in NICM storm than nonstorm patients (72% vs. 88%, P = 0.001). NICM storm patients had worse VA-free survival than ICM storm patients. Conclusion: There are differences in clinical factors and scar patterns in patients undergoing VT ablation who present with VT storm versus those with a nonstorm presentation. Clinical outcomes are worse in NICM storm patients.

Original languageEnglish (US)
Pages (from-to)56-67
Number of pages12
JournalJournal of Cardiovascular Electrophysiology
Volume28
Issue number1
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

Fingerprint

Catheter Ablation
Ventricular Tachycardia
Heart Diseases
Cicatrix
Survival
Cardiac Arrhythmias
Transplants
Anti-Arrhythmia Agents
Incidence
Cardiomyopathies
Stroke Volume

Keywords

  • catheter ablation
  • electrical storm
  • ischemic cardiomyopathy
  • nonischemic cardiomyopathy
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Beyond the Storm : Comparison of Clinical Factors, Arrhythmogenic Substrate, and Catheter Ablation Outcomes in Structural Heart Disease Patients With versus Those Without a History of Ventricular Tachycardia Storm. / Kumar, Saurabh; Fujii, Akira; Kapur, Sunil; Romero, Jorge E.; Mehta, Nishaki K.; Tanigawa, Shinichi; Epstein, Laurence M.; Koplan, Bruce A.; Michaud, Gregory F.; John, Roy M.; Stevenson, William G.; Tedrow, Usha B.

In: Journal of Cardiovascular Electrophysiology, Vol. 28, No. 1, 01.01.2017, p. 56-67.

Research output: Contribution to journalArticle

Kumar, Saurabh ; Fujii, Akira ; Kapur, Sunil ; Romero, Jorge E. ; Mehta, Nishaki K. ; Tanigawa, Shinichi ; Epstein, Laurence M. ; Koplan, Bruce A. ; Michaud, Gregory F. ; John, Roy M. ; Stevenson, William G. ; Tedrow, Usha B. / Beyond the Storm : Comparison of Clinical Factors, Arrhythmogenic Substrate, and Catheter Ablation Outcomes in Structural Heart Disease Patients With versus Those Without a History of Ventricular Tachycardia Storm. In: Journal of Cardiovascular Electrophysiology. 2017 ; Vol. 28, No. 1. pp. 56-67.
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abstract = "Aims: Catheter ablation can be lifesaving in ventricular tachycardia (VT) storm, but the underlying substrate in patients with storm is not well characterized. We sought to compare the clinical factors, substrate, and outcomes differences in patients with sustained monomorphic VT who present for catheter ablation with VT storm versus those with a nonstorm presentation. Methods: Consecutive ischemic (ICM; n = 554) or nonischemic cardiomyopathy patients (NICM; n = 369) with a storm versus nonstorm presentation were studied (ICM storm 186; NICM storm 101). Results: In ICM, storm compared with nonstorm patients had significantly lower left ventricular (LV) ejection fraction (EF), greater number of antiarrhythmic drug (AAD) failures, slower VTs, greater number of scarred LV segments, higher incidence of anterior, septal, and apical endocardial LV scar (all P < 0.05). However, outcomes in follow-up were similar (12-month ventricular arrhythmia [VA]-free survival: 51{\%} vs. 52{\%}, P = 0.6; survival free of death/transplant 75{\%} vs. 87{\%}, P = 0.7). In addition to the above differences, NICM storm patients were also older; however, the extent and distribution of scar was similar except for a higher incidence of lateral endocardial scar in storm patients (P = 0.05). VA-free survival (36{\%} vs. 47{\%}, P = 0.004) and survival free of death/transplant, however, were worse in NICM storm than nonstorm patients (72{\%} vs. 88{\%}, P = 0.001). NICM storm patients had worse VA-free survival than ICM storm patients. Conclusion: There are differences in clinical factors and scar patterns in patients undergoing VT ablation who present with VT storm versus those with a nonstorm presentation. Clinical outcomes are worse in NICM storm patients.",
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T2 - Comparison of Clinical Factors, Arrhythmogenic Substrate, and Catheter Ablation Outcomes in Structural Heart Disease Patients With versus Those Without a History of Ventricular Tachycardia Storm

AU - Kumar, Saurabh

AU - Fujii, Akira

AU - Kapur, Sunil

AU - Romero, Jorge E.

AU - Mehta, Nishaki K.

AU - Tanigawa, Shinichi

AU - Epstein, Laurence M.

AU - Koplan, Bruce A.

AU - Michaud, Gregory F.

AU - John, Roy M.

AU - Stevenson, William G.

AU - Tedrow, Usha B.

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N2 - Aims: Catheter ablation can be lifesaving in ventricular tachycardia (VT) storm, but the underlying substrate in patients with storm is not well characterized. We sought to compare the clinical factors, substrate, and outcomes differences in patients with sustained monomorphic VT who present for catheter ablation with VT storm versus those with a nonstorm presentation. Methods: Consecutive ischemic (ICM; n = 554) or nonischemic cardiomyopathy patients (NICM; n = 369) with a storm versus nonstorm presentation were studied (ICM storm 186; NICM storm 101). Results: In ICM, storm compared with nonstorm patients had significantly lower left ventricular (LV) ejection fraction (EF), greater number of antiarrhythmic drug (AAD) failures, slower VTs, greater number of scarred LV segments, higher incidence of anterior, septal, and apical endocardial LV scar (all P < 0.05). However, outcomes in follow-up were similar (12-month ventricular arrhythmia [VA]-free survival: 51% vs. 52%, P = 0.6; survival free of death/transplant 75% vs. 87%, P = 0.7). In addition to the above differences, NICM storm patients were also older; however, the extent and distribution of scar was similar except for a higher incidence of lateral endocardial scar in storm patients (P = 0.05). VA-free survival (36% vs. 47%, P = 0.004) and survival free of death/transplant, however, were worse in NICM storm than nonstorm patients (72% vs. 88%, P = 0.001). NICM storm patients had worse VA-free survival than ICM storm patients. Conclusion: There are differences in clinical factors and scar patterns in patients undergoing VT ablation who present with VT storm versus those with a nonstorm presentation. Clinical outcomes are worse in NICM storm patients.

AB - Aims: Catheter ablation can be lifesaving in ventricular tachycardia (VT) storm, but the underlying substrate in patients with storm is not well characterized. We sought to compare the clinical factors, substrate, and outcomes differences in patients with sustained monomorphic VT who present for catheter ablation with VT storm versus those with a nonstorm presentation. Methods: Consecutive ischemic (ICM; n = 554) or nonischemic cardiomyopathy patients (NICM; n = 369) with a storm versus nonstorm presentation were studied (ICM storm 186; NICM storm 101). Results: In ICM, storm compared with nonstorm patients had significantly lower left ventricular (LV) ejection fraction (EF), greater number of antiarrhythmic drug (AAD) failures, slower VTs, greater number of scarred LV segments, higher incidence of anterior, septal, and apical endocardial LV scar (all P < 0.05). However, outcomes in follow-up were similar (12-month ventricular arrhythmia [VA]-free survival: 51% vs. 52%, P = 0.6; survival free of death/transplant 75% vs. 87%, P = 0.7). In addition to the above differences, NICM storm patients were also older; however, the extent and distribution of scar was similar except for a higher incidence of lateral endocardial scar in storm patients (P = 0.05). VA-free survival (36% vs. 47%, P = 0.004) and survival free of death/transplant, however, were worse in NICM storm than nonstorm patients (72% vs. 88%, P = 0.001). NICM storm patients had worse VA-free survival than ICM storm patients. Conclusion: There are differences in clinical factors and scar patterns in patients undergoing VT ablation who present with VT storm versus those with a nonstorm presentation. Clinical outcomes are worse in NICM storm patients.

KW - catheter ablation

KW - electrical storm

KW - ischemic cardiomyopathy

KW - nonischemic cardiomyopathy

KW - ventricular tachycardia

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