Catheter Ablation versus Advanced Therapy for Patients with Severe Heart Failure and Ventricular Electrical Storm.

BACKGROUND

Current data on outcomes of an initial strategy of catheter ablation versus advanced therapy in patients with severe HF and ES are limited.

OBJECTIVE

To evaluate the outcomes of ventricular tachycardia (VT) ablation versus left ventricular assist device (LVAD) or heart transplantation (HT) in patients with severe heart failure (HF) and ventricular electric storm (ES).

METHODS

Patients with severe HF and ES who underwent VT ablation, LVAD, or HT between 2012 and 2022 at our medical center were reviewed. Severe HF was defined as ejection fraction ≤ 35% or presence of severe restrictive, valvular or genetic cardiomyopathy. We assessed in-hospital adverse events and one-year outcomes between the two groups.

RESULTS

Of 73 patients, 43 underwent VT ablation and 30 received advanced therapy (21 HT and 9 LVAD). One-year survival was similar (76.7% vs 86.7%, log-rank p = 0.308). However, 10 patients (23.3%) in the ablation group underwent HT during follow up. After multivariable analysis, UNOS status 1 or 2 by VT criteria (HR 5.52, 95% CI: 1.27-24.12; p = 0.023) and early VT recurrence (HR 5.67, 95% CI: 1.68-19.09; p = 0.005) were associated with HT or mortality in patients who underwent VT ablation.

CONCLUSION

Patients with severe HF and ES who underwent VT ablation had similar overall survival as patients who directly proceeded with advanced therapy, although rates of HT were high during follow up. Predictors of HT or mortality after catheter ablation include UNOS status 1 or 2 by VT criteria and early VT recurrence.

Informations de copyright

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