Ce-452777-2 catheter ablation versus advanced therapies for patients with severe heart failure and electrical storm from ventricular arrhythmias

Electrical storm (ES), defined by three or more episodes of sustained ventricular arrhythmia or appropriate defibrillations within 24 hours, is a marker for advanced heart disease and associated with high mortality. Limited studies have reported the outcome of an initial strategy of catheter ablation (CA) versus advanced therapy in patients with severe heart failure and drug-refractory ES. To evaluate the outcomes of CA versus heart transplant (HT) or left ventricular assist device (LVAD) implantation in patients with severe heart failure and ES. Patients with severe heart failure presenting with ES who underwent an initial strategy of CA or advanced therapy between 2012 and 2022 at UC San Diego were included. Severe heart failure was defined as ejection fraction ≤ 35% or having advanced stage genetic cardiomyopathy. We compared in-hospital mortality and long-term survival between the groups. Of 68 patients who met inclusion criteria, 40 patients underwent CA and 28 patients received advanced therapy (8 patients received an LVAD as bridge to transplant). There were no differences in age (62.5 vs 63.0 years, p = 0.69) and male gender (85% vs 89%, p = 0.61), but patients in the advanced therapy group had lower ejection fraction (30% vs 18%, p < 0.01). Inpatient death was comparable between the two groups (10% vs 11%, p = 0.92). There was no difference in survival between the two groups after a median follow up of 3 years (73% vs 75%, log-rank p = 0.471) (Figure). Eleven patients (28%) in the CA group received HT. Time to HT was significantly longer in the CA group (125.5 vs 26.0 days, p < 0.01). In a single-center, retrospective study of patients with severe heart failure and ES, CA was associated with longer transplant-free survival without worsened mortality. Larger studies are needed to evaluate the optimal management strategy in this patient population.