Ablation or conservative management of electrical storm due to monomorphic ventricular tachycardia: differences in outcome

AIMS: Electrical storm (ES) is a life-threatening condition that predicts bad prognosis. Treatment includes antiarrhythmic drugs (AAD) and catheter ablation (CA). The present study aims to retrospectively compare prognosis in terms of survival and ES recurrence in 52 consecutive patients experiencing a first ES episode. METHODS AND RESULTS: Patients were admitted from 1995 to 2011 and treated for ES by conservative therapy (pharmacological, 29 patients) or by CA (23 patients), according to the physician's preference and time of occurrence, i.e. conservative treatments were more frequently administered during the first years of the study, as catheter ablation became more frequent as the years passed by. After a median follow-up of 28 months, no differences either in survival (32% vs. 29% P = 0.8) or in ES recurrence (38% in ablated vs. 57% in non-ablated patients, P = 0.29) were observed between groups. Low left ventricle ejection fraction (LVEF) was the only variable associated with ES recurrence in ablated patients. When including patients with LVEF > 25%, ES recurrence was significantly lower in ablated patients (24 months estimated risk of ES recurrence was 21% vs. 62% in ablated and non-ablated patients, respectively); however, no benefit in survival was observed. CONCLUSION: Our data suggest that in most patients, especially those with an LVEF > 25%, catheter ablation following a first ES episode, decreases the risk of ES recurrence, without increasing survival.