Mueller Julian, Chakarov Ivaylo, Halbfass Philipp, Nentwich Karin, Ene Elena, Berkovitz Artur, Sonne Kai, Barth Sebastian, Waechter Christian, Schupp Tobias, Behnes Michael, Akin Ibrahim, Deneke Thomas
Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, 97616 Bad Neustadt a. d. Saale, Germany.
Department of Cardiology and Angiology, Philipps-University Marburg, 35037 Marburg, Germany.
J Clin Med. 2023 Apr 6;12(7):2730. doi: 10.3390/jcm12072730.
Electrical storm (ES) represents a serious heart rhythm disorder. This study investigates the impact of ES on acute ablation success and long-term outcomes after VT ablation compared to non-ES patients.
In this large single-centre study, patients presenting with ES and undergoing VT ablation from June 2018 to April 2021 were compared to patients undergoing VT ablation due to ventricular tachyarrhythmias but without ES. The primary prognostic outcome was VT recurrence, and secondary endpoints were rehospitalization rates and cardiovascular mortality, all after a median follow-up of 22 months.
A total of 311 patients underwent a first VT ablation due to ventricular tachyarrhythmias and were included (63 ± 14 years; 86% male). Of these, 108 presented with ES. In the ES cohort, dilated cardiomyopathy as underlying heart disease was significantly higher ( = 0.008). Major complications were equal across both groups (all > 0.05). Ablation of the clinical VT was achieved in 94% of all patients ( > 0.05). Noninducibility of any VT was achieved in 91% without ES and in 76% with ES ( = 0.001). Patients with ES revealed increased VT recurrence rates during follow-up (65% vs. 40%; log rank = 0.001; HR 1.841, 95% CI 1.289-2.628; = 0.001). Furthermore, ES patients suffered from increased rehospitalization rates (73% vs. 48%; log rank = 0.001; HR 1.948, 95% CI 1.415-2.682; = 0.001) and cardiovascular mortality (18% vs. 9%; log rank = 0.045; HR 1.948, 95% CI 1.004-3.780; = 0.049). After multivariable adjustment, ES was a strong independent predictor of VT recurrence and rehospitalization rates, but not for mortality. In a propensity score-matched cohort, patients with ES still had a higher risk of VT recurrences and rehospitalizations compared to non-ES patients.
VT ablation in patients with ES is challenging and these patients reveal the highest risk for recurrent VTs, rehospitalization and cardiovascular mortality. These patients need close follow-ups and optimal guideline-directed therapy.
电风暴（ES）是一种严重的心律失常疾病。本研究旨在探讨与非ES患者相比，ES对室性心动过速（VT）消融术后急性消融成功率和长期预后的影响。
在这项大型单中心研究中，将2018年6月至2021年4月期间出现ES并接受VT消融的患者与因室性快速心律失常接受VT消融但无ES的患者进行比较。主要预后指标是VT复发，次要终点是再住院率和心血管死亡率，所有指标均在中位随访22个月后进行评估。
共有311例因室性快速心律失常首次接受VT消融的患者纳入研究（63±14岁；86%为男性）。其中，108例出现ES。在ES队列中，潜在心脏病为扩张型心肌病的比例显著更高（P=0.008）。两组的主要并发症发生率相当（所有P>0.05）。所有患者中94%实现了临床VT的消融（P>0.05）。无ES患者中91%实现了任何VT均不能诱发，有ES患者中这一比例为76%（P=0.001）。ES患者在随访期间VT复发率更高（65%对40%；log秩检验P=0.001；风险比1.841，95%置信区间1.289 - 2.628；P=0.001）。此外，ES患者的再住院率更高（73%对48%；log秩检验P=0.001；风险比1.948，95%置信区间1.415 - 2.682；P=0.001），心血管死亡率也更高（18%对9%；log秩检验P=0.045；风险比1.948，95%置信区间1.004 - 3.780；P=0.049）。多变量调整后，ES是VT复发和再住院率的强独立预测因素，但不是死亡率的预测因素。在倾向评分匹配队列中，与非ES患者相比，ES患者VT复发和再住院的风险仍然更高。
ES患者的VT消融具有挑战性，这些患者VT复发、再住院和心血管死亡的风险最高。这些患者需要密切随访和最佳的指南指导治疗。
