Department of Cardiology, University Hospital of Saint Etienne, Saint-Etienne, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux, France; Department of Cardiology, Haut-Leveque University Hospital, Bordeaux, France.
Department of Cardiology, Lille University Hospital, Lille, France.
JACC Clin Electrophysiol. 2024 Oct;10(10):2117-2128. doi: 10.1016/j.jacep.2024.05.032. Epub 2024 Jul 31.
Electrical storm (ES) is a life-threatening condition, associated with substantial early and subacute mortality. Catheter ablation (CA) is a well-established therapy for ES. However, data regarding the impact of CA on the short-term and midterm survival of patients admitted for ES remain unclear.
This multicenter study aimed to investigate the impact of CA of ES on survival outcomes, while accounting for key patient characteristics associated with treatment selection.
A propensity score-matching (PSM) analysis was performed on 780 consecutive patients admitted for ES in 4 tertiary centers. PSM (1:1) based on the main characteristics associated with the use of CA or medical therapy alone was performed, resulting in 2 groups of 288 patients.
After PSM, patients who underwent CA (n = 288) and those treated with medical therapy alone (n = 288) did not present any significant differences in the main demographic characteristics, ES presentation, and management. Compared with medical therapy alone, CA was associated with a significantly lower rate of ES recurrence at 1 year (5% vs 26%; P < 0.001). Similarly, CA was associated with a higher 1-year (91% vs 81%; P < 0.001) and 3-year (78% vs 71%; P = 0.017) survival after discharge. In subgroup analyses, effect of ablation therapy remained consistent in patients older than 70 years of age (HR: 0.39; 95% CI: 0.24-0.66), with substantial efficacy in patients with a LVEF <35% (HR: 0.39; 95% CI: 0.27-0.59).
In propensity-matched analyses, this large study shows that CA-based management of patients admitted for ES is associated with a reduction in mortality compared with medical treatment, particularly in patients with a low ejection fraction.
电风暴（ES）是一种危及生命的病症，与早期和亚急性期的高死亡率密切相关。导管消融（CA）是治疗 ES 的一种成熟方法。然而，关于 CA 对因 ES 入院患者的短期和中期生存的影响的数据仍不清楚。
本多中心研究旨在调查 CA 对 ES 患者生存结果的影响，同时考虑与治疗选择相关的关键患者特征。
对 4 家三级中心因 ES 入院的 780 例连续患者进行倾向评分匹配（PSM）分析。基于与 CA 或单独药物治疗使用相关的主要特征进行 1:1 的 PSM，得到 2 组各 288 例患者。
经过 PSM 后，接受 CA（n=288）和单独接受药物治疗（n=288）的患者在主要人口统计学特征、ES 表现和管理方面没有任何显著差异。与单独药物治疗相比，CA 治疗组在 1 年时 ES 复发率显著降低（5% vs. 26%；P<0.001）。同样，CA 治疗组在 1 年（91% vs. 81%；P<0.001）和 3 年（78% vs. 71%；P=0.017）的出院后生存率也更高。亚组分析显示，消融治疗的效果在年龄大于 70 岁的患者中保持一致（HR：0.39；95%CI：0.24-0.66），在 LVEF<35%的患者中具有显著疗效（HR：0.39；95%CI：0.27-0.59）。
在倾向评分匹配分析中，这项大型研究表明，与药物治疗相比，因 ES 入院患者的 CA 管理与死亡率降低相关，特别是在射血分数较低的患者中。
