Early catheter ablation for electrical storm was independently associated with lower cardiovascular mortality compared to medical therapy alone (adjusted OR 0.28; 95% CI 0.08-0.92; p=0.036).
Cohort (n=127)
No
Does early catheter ablation reduce mortality and VT recurrence in patients with electrical storm compared to medical therapy alone?
Early catheter ablation during the index hospitalization for electrical storm is independently associated with reduced cardiovascular mortality compared to medical therapy alone.
Effect estimate: adjusted OR 0.28 (95% CI 0.08-0.92)
Absolute Event Rate: 8.7% vs 29.3%
p-value: p=0.036
Abstract Background Electrical storm (ES) is a life-threatening arrhythmic emergency associated with high morbidity and mortality. While initial management relies on antiarrhythmic therapy, beta-blockers, sedation, and hemodynamic support, early catheter ablation (CA) has emerged as a potential strategy to improve outcomes. This study compared early CA with medical therapy alone in patients presenting with ES. Methods We conducted a single-center retrospective study including consecutive patients admitted to the CICU between 2015 and 2025 with a first episode of ES during admission, defined as ≥3 episodes of ventricular arrhythmia within 24 hours. Patients were grouped according to management strategy: medical therapy alone or CA performed during the index hospitalization. The primary outcomes were in-hospital mortality, cardiovascular (CV) mortality during follow-up, and ventricular tachycardia (VT) recurrence. Clinical, procedural, and follow-up data were analyzed, and multivariable logistic regression was used to identify independent predictors of CV mortality and VT recurrence. Results A total of 127 patients were included (mean age 65 ± 14 years; 88% male): 69 (54%) underwent CA and 58 (46%) received medical therapy alone. The majority had ischemic structural heart disease (59%), followed by non-ischemic cardiomyopathy (39%). Patients managed medically had more acute myocardial infarction at admission (22% vs. 3%, p0.001), OHCA (12% vs. 1%, p=0.023), and identifiable triggers (47% vs. 13%, p0.001). During hospitalization, 33% required continuous sedation, 30% mechanical ventilation, and 26% vasoactive support. Compared with the medical therapy group, CA patients required less sedation (25% vs. 43%, p=0.044), ventilation (19% vs. 43%, p=0.005), and vasoactive drugs (17% vs. 36%, p=0.027), suggesting greater initial stability. Median time to ablation was 5 days 3-8, and median hospital stay was 11 days 6-20. In-hospital mortality was significantly lower in the CA group (4.3% vs. 22.4%, p=0.003) Figure 1A. After a median follow-up of 2.1 years 0.4–3.5, CV mortality occurred in 18% and VT recurrence in 29% of patients, with median times to event of 1.1 months 0.5-4.0 and 4.0 months 1.5-13.0, respectively. CV mortality during follow-up was lower in the CA group (8.7% vs. 29.3%, p=0.006) Figure 1B, whereas VT recurrence rates did not differ between groups Figure 1C. In multivariate analysis, CA was an independent predictor of CV mortality adjusted for creatinine and PAINESD score (adjusted OR 0.28, 95% CI 0.08–0.92, p=0.036). No independent predictors of VT recurrence were identified. Conclusion Patients treated medically had more severe presentations and reversible causes of ES, reflecting substantial baseline differences between groups. In multivariate analysis, early CA remained independently associated with lower cardiovascular mortality, supporting its potential role as an early interventional strategy in ES management.Figure 1
Carvalho et al. (2026) conducted a cohort in Electrical storm (n=127). Early catheter ablation vs. Medical therapy alone was evaluated on Cardiovascular mortality during follow-up (adjusted OR 0.28, 95% CI 0.08-0.92, p=0.036). Early catheter ablation for electrical storm was independently associated with lower cardiovascular mortality compared to medical therapy alone (adjusted OR 0.28; 95% CI 0.08-0.92; p=0.036).