Catheter Ablation Versus Medical Therapy as First-Line Treatment for Ventricular Electrical Storm: A Systematic...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Interventions

Background:

• Electrical storm (ES) is a critical condition characterized by recurrent ventricular arrhythmias.
• Current first-line treatments primarily involve anti-arrhythmic drugs (AADs), but catheter ablation (CA) is emerging as a potential alternative.
• The comparative efficacy and safety of CA versus escalating medical therapy for ES require further clarification.

Purpose of the Study:

• To evaluate the effectiveness and safety of radiofrequency catheter ablation (CA) compared to medical therapy (MT) as an initial treatment for electrical storm (ES).
• To assess the impact of CA on ES recurrence, ventricular arrhythmia (VA) recurrence, in-hospital mortality, and long-term survival.

Main Methods:

• A systematic literature review and meta-analysis were performed, searching PubMed, Science Direct, and Cochrane databases for relevant studies from 2010 to 2025.
• Studies comparing first-line CA with escalating MT for ES were included.
• Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models to analyze outcomes.

Main Results:

• Six studies involving 963 patients (473 CA, 490 MT) were analyzed.
• Catheter ablation demonstrated a 71% reduction in ES recurrence compared to medical therapy (OR: 0.29; 95% CI: 0.15-0.53).
• CA was associated with significantly lower VA recurrence, in-hospital mortality, and improved long-term survival.

Conclusions:

• Catheter ablation is a superior first-line strategy for managing electrical storm, offering reduced recurrence and mortality.
• Findings support considering CA as an initial therapy for ES patients.
• Further large-scale prospective trials are warranted to confirm these results and refine patient selection criteria.