Carbucicchio Corrado, Santamaria Matteo, Trevisi Nicola, Maccabelli Giuseppe, Giraldi Francesco, Fassini Gaetano, Riva Stefania, Moltrasio Massimo, Cireddu Manuela, Veglia Fabrizio, Della Bella Paolo
Arrhythmia Department, Institute of Cardiology, University of Milan, IRCCS-Centro Cardiologico Monzino, Via Parea, 4, 20138-Milan, Italy.
Circulation. 2008 Jan 29;117(4):462-9. doi: 10.1161/CIRCULATIONAHA.106.686534. Epub 2008 Jan 2.
Electrical storm (ES) caused by recurrent episodes of ventricular tachycardia (VT) can cause sudden death in patients with implantable cardioverter-defibrillators and adversely affects prognosis in survivors. Catheter ablation has been proposed for treating ES, but its long-term effect in a large population has never been verified.
Ninety-five consecutive patients with coronary artery disease (72 patients), idiopathic dilated cardiomyopathy (10 patients), and arrhythmogenic right ventricular dysplasia/cardiomyopathy (13 patients) undergoing catheter ablation for drug-refractory ES were prospectively evaluated. Short-term efficacy was defined by a complete protocol of programmed electric stimulation and by in-hospital outcome; long-term analysis addressed ES recurrence, cardiac mortality, and VT recurrence. Pleomorphic/nontolerated VTs required electroanatomic and noncontact mapping in 48 and 22 patients, respectively, and percutaneous cardiopulmonary support in 10 patients. An epicardial approach was used in 10 patients. After 1 to 3 procedures, induction of any clinical VT(s) by programmed electrical stimulation was prevented in 85 patients (89%). ES was acutely suppressed in all patients; a minimum period of 7 days with stable rhythm was required before hospital discharge. At a median follow-up of 22 months (range, 1 to 43 months), 87 patients (92%) were free of ES and 63 patients (66%) were free of VT recurrence. Eight of 10 patients with persistent inducibility of clinical VT(s) had ES recurrence; 4 of them died suddenly despite appropriate implantable cardioverter-defibrillator intervention. All together, 11 of 95 patients (12%) died of cardiac-related reasons. In the group of patients presenting with all clinical VTs acutely abolished, no ES recurrence was documented, and cardiac mortality was significantly lower compared with the group of patients showing > or = 1 clinical VT still inducible after catheter ablation.
Advanced strategies of catheter ablation applied to a large population of patients are effective in the short-term treatment of ES. By preventing ES recurrence, catheter ablation may play a protective role over the long term and, together with long-term pharmacological therapy, may favorably affect cardiac mortality.
由室性心动过速（VT）反复发作引起的电风暴（ES）可导致植入式心脏复律除颤器患者猝死，并对幸存者的预后产生不利影响。导管消融已被提议用于治疗ES，但其在大量人群中的长期效果尚未得到证实。
对95例因药物难治性ES接受导管消融的患者进行前瞻性评估，其中包括72例冠心病患者、10例特发性扩张型心肌病患者和13例致心律失常性右室发育不良/心肌病患者。短期疗效通过程控电刺激的完整方案和住院结局来定义；长期分析关注ES复发、心脏死亡率和VT复发。48例和22例患者分别因多形性/不耐受性VT需要进行电解剖和非接触标测，10例患者需要经皮心肺支持。10例患者采用了心外膜途径。经过1至3次手术，85例患者（89%）通过程控电刺激未能诱发任何临床VT。所有患者的ES均得到急性抑制；出院前需要有至少7天的稳定心律期。在中位随访22个月（范围1至43个月）时，87例患者（92%）无ES复发且63例患者（66%）无VT复发。10例临床VT持续可诱发的患者中有8例出现ES复发；其中4例尽管接受了适当的植入式心脏复律除颤器干预仍猝死。95例患者中共有11例（12%）死于心脏相关原因。在所有临床VT均被急性消除的患者组中，未记录到ES复发，且与导管消融后仍有≥1例临床VT可诱发的患者组相比，心脏死亡率显著降低。
应用于大量患者的先进导管消融策略在ES的短期治疗中是有效的。通过预防ES复发，导管消融可能在长期发挥保护作用，并且与长期药物治疗一起，可能对心脏死亡率产生有利影响。
