Venturing into ventricular arrhythmia storm: a systematic review and meta-analysis.
Sachin Nayyar1, Anand N Ganesan, Anthony G Brooks
1Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA 5000, Australia. sachin.nayyar@adelaide.edu.au
European Heart Journal
|December 25, 2012
Summary
Catheter ablation for ventricular arrhythmia storm is a life-saving procedure with high acute success rates. While recurrence is low, long-term mortality is dominated by heart failure, and failed procedures carry significant risk.
Area of Science:
- Cardiology
- Electrophysiology
- Interventional Cardiology
Background:
- Catheter ablation is established for ventricular arrhythmia (VA) management.
- VA storm ablation is often reported in small series, necessitating a comprehensive synthesis.
Purpose of the Study:
- To systematically review and analyze the efficacy and safety of catheter ablation for ventricular arrhythmia storm.
- To consolidate existing literature on VA storm ablation outcomes.
Main Methods:
- Systematic literature search of medical electronic databases up to January 31, 2012.
- Inclusion of studies reporting on VA storm patients (recurrent or incessant VA).
- Meta-analysis of data from 471 patients across 39 publications.
Main Results:
- High acute procedural success rate of 72% for VA storm ablation.
- Low procedural mortality (0.6%) and recurrence rate (6%).
- Significantly higher recurrence for monomorphic VT storm compared to other VA types (OR 3.76).
- Long-term mortality was 17%, with heart failure as the primary cause (62%).
- Failed ablation procedures were associated with a four-fold increased odds of death (95% CI: 2.04-8.01).
Conclusions:
- Catheter ablation for ventricular arrhythmia storm demonstrates high acute efficacy and low recurrence rates.
- Heart failure represents the leading cause of long-term mortality post-ablation.
- Acute procedural failure significantly elevates mortality risk, underscoring the importance of procedural success.
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