Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Cardiovascular Research Center, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
J Cardiovasc Electrophysiol. 2020 Jan;31(1):9-17. doi: 10.1111/jce.14309. Epub 2019 Dec 15.
The management of refractory electrical storm (ES) requiring mechanical circulation support (MCS) remains a clinical challenge in structural heart disease (SHD).
The study sought to explore the 30-day and 1-year outcome of rescue ablation for refractory ES requiring MCS in SHD.
A total of 81 patients (mean age: 55.3 ± 18.9, 73 men [90.1%]) undergoing ablation were investigated, including 26 patients with ES requiring MCS (group 1) and 55 patients without (group 2). The 30-day and 1-year outcome, including mortality and recurrent ventricular tachyarrhythmias (VAs) receiving appropriate implantable cardioverter defibrillators therapies, were assessed.
The patients in group 1 were characterized by older age, more ischemic cardiomyopathies, worse left ventricular ejection fraction, and more comorbidities. Thirty days after ablation, overall events were seen in 15 patients (mortality in 10 and recurrent VA in 7), including pumping failure-related mortality in 6 (60%). During a 30-day follow-up, higher mortality was noted in group 1. After a 1-year follow-up, in spite of the higher mortality in group 1 (P < .001), the overall events and VA recurrences were similar between these two groups (P = .154 and P = .466, respectively). There was a significant reduction of VA burden in both groups and two patients had recurrent ES.
Higher 30-day mortality was observed in patients undergoing rescue ablation for refractory ES requiring MCS, and pumping failure was the major cause of periprocedural death. Rescue ablation successfully prevented VA recurrences and resulted in a comparable 1-year prognosis between ES with and without MCS.
在结构性心脏病（SHD）中，需要机械循环支持（MCS）的难治性电风暴（ES）的管理仍然是一个临床挑战。
本研究旨在探讨需要 MCS 的难治性 ES 患者行挽救性消融的 30 天和 1 年预后。
共纳入 81 例行消融术的患者（平均年龄：55.3±18.9 岁，73 名男性[90.1%]），包括 26 例 ES 需要 MCS（组 1）和 55 例不需要（组 2）。评估了 30 天和 1 年的结果，包括死亡率和接受适当植入式心脏复律除颤器治疗的复发性室性心动过速（VTs）。
组 1 患者的特点是年龄较大、更多缺血性心肌病、左心室射血分数较低以及更多合并症。消融后 30 天，15 例患者出现总体事件（死亡 10 例，复发性 VT 7 例），包括 6 例（60%）因泵衰竭相关死亡。在 30 天随访期间，组 1 死亡率较高。在 1 年随访后，尽管组 1 死亡率较高（P<0.001），但两组之间的总体事件和 VT 复发率相似（P=0.154 和 P=0.466）。两组的 VT 负荷均显著降低，有 2 例患者出现复发性 ES。
需要 MCS 的难治性 ES 患者行挽救性消融后 30 天死亡率较高，围手术期死亡的主要原因是泵衰竭。挽救性消融成功预防了 VT 复发，使 ES 伴或不伴 MCS 的 1 年预后相似。
