Feasibility and safety of catheter ablation of electrical storm in ischemic dilated cardiomyopathy

Antonio Dello Russo, Michela Casella, Gemma Pelargonio, Pasquale Santangeli, Stefano Bartoletti, Gianluigi Bencardino, Ghaliah Al-Mohani, Ester Innocenti, Luigi Di Biase, Andrea Avella, Augusto Pappalardo, Corrado Carbucicchio, Fulvio Bellocci, Cesare Fiorentini, Andrea Natale, Claudio Tondo

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Aims Electrical storm is an emergency in 'implantation of a cardioverter defibrillator' carriers with ischemic dilated cardiomyopathy (DCM) and negatively impacts long-term prognosis. We evaluated the feasibility, safety, and effectiveness of radiofrequency catheter ablation (RFCA) in controlling electrical storm and its impact on survival and ventricular tachycardia/fibrillation recurrence. Methods We enrolled 27 consecutive patients (25 men, age 73.1 ± 6.5 years) with ischemic DCM and an indication to RFCA for drug-refractory electrical storm. The immediate outcome was defined as failure or success, depending on whether the patient's clinical ventricular tachycardia could still be induced after RFCA; electrical storm resolution was defined as no sustained ventricular tachycardia/ventricular fibrillation in the next 7 days. Results Of the 27 patients, 1 died before RFCA; in the remaining 26 patients, a total of 33 RFCAs were performed. In all 26 patients, RFCA was successful, although in 6/26 patients (23.1%), repeated procedures were needed, including epicardial ablation in 3/26 (11.5%). In 23/26 patients (88.5%), electrical storm resolution was achieved. At a follow-up of 16.7 ± 8.1 months, 5/26 patients (19.2%) had died (3 nonsudden cardiac deaths, 2 noncardiac deaths) and 10/26 patients (38.5%) had ventricular tachycardia recurrence; none had electrical storm recurrence. A worse long-term outcome was associated with lower glomerular filtration rate, wider baseline QRS, and presence of atrial fibrillation before electrical storm onset. Conclusion In patients with ischemic DCM, RFCA is well tolerated, feasible and effective in the acute management of drug-refractory electrical storm. It is associated with a high rate of absence of sustained ventricular tachycardia episodes over the subsequent 7 days. After successful ablation, long-term outcome was mainly predicted by baseline clinical variables.

Original languageEnglish (US)
Pages (from-to)425-432
Number of pages8
JournalJournal of Cardiovascular Medicine
Volume17
Issue number6
DOIs
StatePublished - Jun 1 2016
Externally publishedYes

Fingerprint

Catheter Ablation
Dilated Cardiomyopathy
Safety
Ventricular Tachycardia
Ventricular Fibrillation
Recurrence
Defibrillators
Glomerular Filtration Rate
Pharmaceutical Preparations
Atrial Fibrillation
Emergencies

Keywords

  • catheter ablation
  • electrical storm
  • ischemic dilated cardiomyopathy
  • ischemic heart disease
  • ventricular fibrillation
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Dello Russo, A., Casella, M., Pelargonio, G., Santangeli, P., Bartoletti, S., Bencardino, G., ... Tondo, C. (2016). Feasibility and safety of catheter ablation of electrical storm in ischemic dilated cardiomyopathy. Journal of Cardiovascular Medicine, 17(6), 425-432. https://doi.org/10.2459/JCM.0000000000000259

Feasibility and safety of catheter ablation of electrical storm in ischemic dilated cardiomyopathy. / Dello Russo, Antonio; Casella, Michela; Pelargonio, Gemma; Santangeli, Pasquale; Bartoletti, Stefano; Bencardino, Gianluigi; Al-Mohani, Ghaliah; Innocenti, Ester; Di Biase, Luigi; Avella, Andrea; Pappalardo, Augusto; Carbucicchio, Corrado; Bellocci, Fulvio; Fiorentini, Cesare; Natale, Andrea; Tondo, Claudio.

In: Journal of Cardiovascular Medicine, Vol. 17, No. 6, 01.06.2016, p. 425-432.

Research output: Contribution to journalArticle

Dello Russo, A, Casella, M, Pelargonio, G, Santangeli, P, Bartoletti, S, Bencardino, G, Al-Mohani, G, Innocenti, E, Di Biase, L, Avella, A, Pappalardo, A, Carbucicchio, C, Bellocci, F, Fiorentini, C, Natale, A & Tondo, C 2016, 'Feasibility and safety of catheter ablation of electrical storm in ischemic dilated cardiomyopathy', Journal of Cardiovascular Medicine, vol. 17, no. 6, pp. 425-432. https://doi.org/10.2459/JCM.0000000000000259
Dello Russo A, Casella M, Pelargonio G, Santangeli P, Bartoletti S, Bencardino G et al. Feasibility and safety of catheter ablation of electrical storm in ischemic dilated cardiomyopathy. Journal of Cardiovascular Medicine. 2016 Jun 1;17(6):425-432. https://doi.org/10.2459/JCM.0000000000000259
Dello Russo, Antonio ; Casella, Michela ; Pelargonio, Gemma ; Santangeli, Pasquale ; Bartoletti, Stefano ; Bencardino, Gianluigi ; Al-Mohani, Ghaliah ; Innocenti, Ester ; Di Biase, Luigi ; Avella, Andrea ; Pappalardo, Augusto ; Carbucicchio, Corrado ; Bellocci, Fulvio ; Fiorentini, Cesare ; Natale, Andrea ; Tondo, Claudio. / Feasibility and safety of catheter ablation of electrical storm in ischemic dilated cardiomyopathy. In: Journal of Cardiovascular Medicine. 2016 ; Vol. 17, No. 6. pp. 425-432.
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abstract = "Aims Electrical storm is an emergency in 'implantation of a cardioverter defibrillator' carriers with ischemic dilated cardiomyopathy (DCM) and negatively impacts long-term prognosis. We evaluated the feasibility, safety, and effectiveness of radiofrequency catheter ablation (RFCA) in controlling electrical storm and its impact on survival and ventricular tachycardia/fibrillation recurrence. Methods We enrolled 27 consecutive patients (25 men, age 73.1 ± 6.5 years) with ischemic DCM and an indication to RFCA for drug-refractory electrical storm. The immediate outcome was defined as failure or success, depending on whether the patient's clinical ventricular tachycardia could still be induced after RFCA; electrical storm resolution was defined as no sustained ventricular tachycardia/ventricular fibrillation in the next 7 days. Results Of the 27 patients, 1 died before RFCA; in the remaining 26 patients, a total of 33 RFCAs were performed. In all 26 patients, RFCA was successful, although in 6/26 patients (23.1{\%}), repeated procedures were needed, including epicardial ablation in 3/26 (11.5{\%}). In 23/26 patients (88.5{\%}), electrical storm resolution was achieved. At a follow-up of 16.7 ± 8.1 months, 5/26 patients (19.2{\%}) had died (3 nonsudden cardiac deaths, 2 noncardiac deaths) and 10/26 patients (38.5{\%}) had ventricular tachycardia recurrence; none had electrical storm recurrence. A worse long-term outcome was associated with lower glomerular filtration rate, wider baseline QRS, and presence of atrial fibrillation before electrical storm onset. Conclusion In patients with ischemic DCM, RFCA is well tolerated, feasible and effective in the acute management of drug-refractory electrical storm. It is associated with a high rate of absence of sustained ventricular tachycardia episodes over the subsequent 7 days. After successful ablation, long-term outcome was mainly predicted by baseline clinical variables.",
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T1 - Feasibility and safety of catheter ablation of electrical storm in ischemic dilated cardiomyopathy

AU - Dello Russo, Antonio

AU - Casella, Michela

AU - Pelargonio, Gemma

AU - Santangeli, Pasquale

AU - Bartoletti, Stefano

AU - Bencardino, Gianluigi

AU - Al-Mohani, Ghaliah

AU - Innocenti, Ester

AU - Di Biase, Luigi

AU - Avella, Andrea

AU - Pappalardo, Augusto

AU - Carbucicchio, Corrado

AU - Bellocci, Fulvio

AU - Fiorentini, Cesare

AU - Natale, Andrea

AU - Tondo, Claudio

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N2 - Aims Electrical storm is an emergency in 'implantation of a cardioverter defibrillator' carriers with ischemic dilated cardiomyopathy (DCM) and negatively impacts long-term prognosis. We evaluated the feasibility, safety, and effectiveness of radiofrequency catheter ablation (RFCA) in controlling electrical storm and its impact on survival and ventricular tachycardia/fibrillation recurrence. Methods We enrolled 27 consecutive patients (25 men, age 73.1 ± 6.5 years) with ischemic DCM and an indication to RFCA for drug-refractory electrical storm. The immediate outcome was defined as failure or success, depending on whether the patient's clinical ventricular tachycardia could still be induced after RFCA; electrical storm resolution was defined as no sustained ventricular tachycardia/ventricular fibrillation in the next 7 days. Results Of the 27 patients, 1 died before RFCA; in the remaining 26 patients, a total of 33 RFCAs were performed. In all 26 patients, RFCA was successful, although in 6/26 patients (23.1%), repeated procedures were needed, including epicardial ablation in 3/26 (11.5%). In 23/26 patients (88.5%), electrical storm resolution was achieved. At a follow-up of 16.7 ± 8.1 months, 5/26 patients (19.2%) had died (3 nonsudden cardiac deaths, 2 noncardiac deaths) and 10/26 patients (38.5%) had ventricular tachycardia recurrence; none had electrical storm recurrence. A worse long-term outcome was associated with lower glomerular filtration rate, wider baseline QRS, and presence of atrial fibrillation before electrical storm onset. Conclusion In patients with ischemic DCM, RFCA is well tolerated, feasible and effective in the acute management of drug-refractory electrical storm. It is associated with a high rate of absence of sustained ventricular tachycardia episodes over the subsequent 7 days. After successful ablation, long-term outcome was mainly predicted by baseline clinical variables.

AB - Aims Electrical storm is an emergency in 'implantation of a cardioverter defibrillator' carriers with ischemic dilated cardiomyopathy (DCM) and negatively impacts long-term prognosis. We evaluated the feasibility, safety, and effectiveness of radiofrequency catheter ablation (RFCA) in controlling electrical storm and its impact on survival and ventricular tachycardia/fibrillation recurrence. Methods We enrolled 27 consecutive patients (25 men, age 73.1 ± 6.5 years) with ischemic DCM and an indication to RFCA for drug-refractory electrical storm. The immediate outcome was defined as failure or success, depending on whether the patient's clinical ventricular tachycardia could still be induced after RFCA; electrical storm resolution was defined as no sustained ventricular tachycardia/ventricular fibrillation in the next 7 days. Results Of the 27 patients, 1 died before RFCA; in the remaining 26 patients, a total of 33 RFCAs were performed. In all 26 patients, RFCA was successful, although in 6/26 patients (23.1%), repeated procedures were needed, including epicardial ablation in 3/26 (11.5%). In 23/26 patients (88.5%), electrical storm resolution was achieved. At a follow-up of 16.7 ± 8.1 months, 5/26 patients (19.2%) had died (3 nonsudden cardiac deaths, 2 noncardiac deaths) and 10/26 patients (38.5%) had ventricular tachycardia recurrence; none had electrical storm recurrence. A worse long-term outcome was associated with lower glomerular filtration rate, wider baseline QRS, and presence of atrial fibrillation before electrical storm onset. Conclusion In patients with ischemic DCM, RFCA is well tolerated, feasible and effective in the acute management of drug-refractory electrical storm. It is associated with a high rate of absence of sustained ventricular tachycardia episodes over the subsequent 7 days. After successful ablation, long-term outcome was mainly predicted by baseline clinical variables.

KW - catheter ablation

KW - electrical storm

KW - ischemic dilated cardiomyopathy

KW - ischemic heart disease

KW - ventricular fibrillation

KW - ventricular tachycardia

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