Catheter ablation vs advanced therapy for patients with severe heart failure and ventricular electrical storm.

Background: Current data on outcomes of an initial strategy of catheter ablation vs advanced therapy in patients with severe heart failure (HF) and electric storm (ES) are limited.

Objective: The purpose of this study was to evaluate the outcomes of ventricular tachycardia (VT) ablation vs left ventricular assist device (LVAD) or heart transplantation (HT) in patients with severe HF and ventricular ES.

Methods: Patients with severe HF and ES who underwent VT ablation, LVAD, or HT between 2012 and 2022 at our medical center were reviewed. Severe HF was defined as ejection fraction ≤ 35% or presence of severe restrictive, valvular, or genetic cardiomyopathy. We assessed in-hospital adverse events and 1-year outcomes between the 2 groups.

Results: Of the 73 patients, 43 (58.9%) underwent VT ablation and 30 (41.1%) received advanced therapy (21 HT (70%) and 9 LVAD (30%)). One-year survival was similar (76.7% vs 86.7%; log-rank, P = .308). However, 10 patients (23.3%) in the ablation group underwent HT during follow-up. After multivariable analysis, United Network for Organ Sharing status 1 or 2 according to VT criteria (hazard ratio 5.52; 95% confidence interval 1.27-24.12; P = .023) and early VT recurrence (hazard ratio 5.67; 95% confidence interval 1.68-19.09; P = .005) were associated with HT or mortality in patients who underwent VT ablation.

Conclusion: Patients with severe HF and ES who underwent VT ablation had similar overall survival to patients who directly proceeded with advanced therapy, although rates of HT were high during follow-up. Predictors of HT or mortality after catheter ablation include United Network for Organ Sharing status 1 or 2 according to VT criteria and early VT recurrence.