Ninni Sandro, Guenancia Charles, Bourdrel Ophélie, Mohammed Rayan, Decaudin Donovan, Klein Cédric, Salaun Alexandre, Sava Ruxandra, Tazibet Amine, M'Rabet Soundous, Guinot Pierre Grégoire, Groussin Pierre, Da Costa Antoine, Pavin Dominique, Klug Didier, Martins Raphaël, Benali Karim
Department of Cardiology, Lille University Hospital, 59000 Lille, France.
Department of Cardiology, Dijon University Hospital, Dijon, France.
Europace. 2025 Sep 1;27(9). doi: 10.1093/europace/euaf188.
Catheter ablation (CA) plays a central role in the management of electrical storm (ES). PAINESD and iVT are two validated scores commonly used to assess periprocedural risk in patients undergoing ventricular tachycardia (VT) ablation. This study aimed to evaluate the association between CA and mortality in ES patients stratified by PAINESD and iVT risk scores.
We included 606 patients admitted for ES across four French centres. Risk was assessed using PAINESD and iVT scores. Mortality at 1 year was compared according to risk group and CA status. Baseline differences were adjusted using inverse probability of treatment weighting (IPTW) based on predefined clinical variables. Forty-one per cent of patients were classified as high-risk using the PAINESD score, and 39.4% using the iVT score. Catheter ablation was performed in 42.4% of the cohort, including 39.4% of hi-PAINESD and 35.5% of hi-iVT patients. After adjustment, CA was associated with lower 1-year mortality in both high- and low-risk groups (adjusted HR: 0.42 [95% CI: 0.26-0.66], P = 0.0002 for hi-PAINESD; 0.31 [0.18-0.53], P < 0.0001 for hi-iVT). Inverse probability of treatment weighting-weighted models yielded consistent results. In exploratory interaction analyses, the iVT score-but not PAINESD-identified high-risk patients who may derive earlier survival benefit from VT ablation.
In patients with electrical storm, VT ablation was associated with lower 1-year mortality across both low- and high-risk profiles. The iVT score may help identify high-risk patients who derive earlier benefit from ablation.
导管消融术（CA）在电风暴（ES）的治疗中起着核心作用。PAINESD和iVT是两个经过验证的评分，常用于评估接受室性心动过速（VT）消融术患者的围手术期风险。本研究旨在评估根据PAINESD和iVT风险评分分层的ES患者中CA与死亡率之间的关联。
我们纳入了法国四个中心收治的606例ES患者。使用PAINESD和iVT评分评估风险。根据风险组和CA状态比较1年时的死亡率。基于预先定义的临床变量，使用治疗权重的逆概率（IPTW）调整基线差异。使用PAINESD评分，41%的患者被分类为高危，使用iVT评分则为39.4%。42.4%的队列患者接受了导管消融术，其中包括39.4%的高PAINESD患者和35.5%的高iVT患者。调整后，CA与高风险组和低风险组的1年死亡率降低均相关（高PAINESD组调整后的HR：0.42[95%CI：0.26 - 0.66]，P = 0.0002；高iVT组为0.31[0.18 - 0.53]，P < 0.0001）。治疗权重的逆概率加权模型产生了一致的结果。在探索性交互分析中，iVT评分而非PAINESD评分识别出可能从VT消融术中更早获得生存益处的高危患者。
在电风暴患者中，VT消融术与低风险和高风险患者的1年死亡率降低均相关。iVT评分可能有助于识别能更早从消融术中获益的高危患者。
