Predicting Survival in Ventricular Tachycardia Storm: The CHAMPS Risk Score and Implications for Ablation Timing

Ventricular tachycardia (VT) storm is associated with substantial risk of in-hospital mortality. There are limited data on which patients are at highest risk and the optimal timing of catheter ablation for VT.

This study sought to identify predictors of in-hospital mortality among patients with VT storm, develop a mortality risk score, and evaluate the impact of ablation timing across risk strata.

Retrospective analysis of patients admitted with VT storm at 6 high-volume tertiary care centers between 2015 and 2024. Multivariable logistic regression was used to identify independent predictors of acute in-hospital mortality. A weighted clinical risk score-the CHAMPS (cerebrovascular accident, hypoxia, admission diagnosis, malnutrition, vasopressors, sepsis) score-was developed from these predictors. Mortality rates were compared across risk strata and by timing of VT ablation.

A total of 1,675 patients met inclusion criteria and 363 (22%) died during the index hospitalization. Independent predictors of mortality included acute cerebrovascular accident (OR: 3.9), hypoxia resulting in intubation (OR: 3.8), an admission diagnosis other than VT (OR: 4.1), severe malnutrition (OR: 1.4), multiple vasopressor agents (OR: 1.8), and sepsis or fever (OR: 5.0). Using the proportionally weighted CHAMPS score, mortality was 6.6% in low-risk patients, 26.7% in moderate-risk patients, and 60.7% in high-risk patients. VT ablation was performed in 59% of patients and early ablation performed within 7 days of developing VT storm was protective against in hospital mortality (OR: 0.01), independent of CHAMPS score.

VT storm is associated with high risk of acute in-hospital mortality and the CHAMPS score identifies patients at highest risk. Early catheter ablation is associated with significantly improved survival across risk categories.