Impact of ventricular tachycardia ablation in the setting of electrical storm based on patient risk profile
Sandro Ninni1, Charles Guenancia2, Ophélie Bourdrel1
1Department of Cardiology, Lille University Hospital, 59000 Lille, France.
Insights
Catheter ablation for electrical storm significantly reduces 1-year mortality in both high- and low-risk patients. The iVT score helps identify those who benefit most from ventricular tachycardia ablation.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Risk Stratification
Background:
- Catheter ablation (CA) is crucial for managing electrical storm (ES).
- PAINESD and iVT are validated risk scores for ventricular tachycardia (VT) ablation.
- Evaluating CA's impact on mortality in ES patients, stratified by risk scores, is essential.
Purpose of the Study:
- To assess the association between catheter ablation and mortality in electrical storm patients.
- To stratify patients based on PAINESD and iVT risk scores.
- To determine if risk stratification influences the benefit of catheter ablation.
Main Methods:
- Included 606 patients admitted for ES across four French centers.
- Assessed risk using PAINESD and iVT scores.
- Adjusted for baseline differences using inverse probability of treatment weighting (IPTW).
Main Results:
- 41% and 39.4% of patients were high-risk by PAINESD and iVT scores, respectively.
- CA was performed in 42.4% of patients.
- CA was associated with significantly lower 1-year mortality in both high- and low-risk groups (adjusted HRs < 0.66).
Conclusions:
- Ventricular tachycardia ablation reduces 1-year mortality in electrical storm patients, irrespective of risk profile.
- The iVT score may identify high-risk patients who benefit earlier from ablation.
Aims:
Catheter ablation (CA) plays a central role in the management of electrical storm (ES). PAINESD and iVT are two validated scores commonly used to assess periprocedural risk in patients undergoing ventricular tachycardia (VT) ablation. This study aimed to evaluate the association between CA and mortality in ES patients stratified by PAINESD and iVT risk scores.
Methods And Results:
We included 606 patients admitted for ES across four French centres. Risk was assessed using PAINESD and iVT scores. Mortality at 1 year was compared according to risk group and CA status. Baseline differences were adjusted using inverse probability of treatment weighting (IPTW) based on predefined clinical variables. Forty-one per cent of patients were classified as high-risk using the PAINESD score, and 39.4% using the iVT score. Catheter ablation was performed in 42.4% of the cohort, including 39.4% of hi-PAINESD and 35.5% of hi-iVT patients. After adjustment, CA was associated with lower 1-year mortality in both high- and low-risk groups (adjusted HR: 0.42 [95% CI: 0.26-0.66], P = 0.0002 for hi-PAINESD; 0.31 [0.18-0.53], P < 0.0001 for hi-iVT). Inverse probability of treatment weighting-weighted models yielded consistent results. In exploratory interaction analyses, the iVT score-but not PAINESD-identified high-risk patients who may derive earlier survival benefit from VT ablation.
Conclusion:
In patients with electrical storm, VT ablation was associated with lower 1-year mortality across both low- and high-risk profiles. The iVT score may help identify high-risk patients who derive earlier benefit from ablation.
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