Multiple Ablation Approaches Supplemented By Surgical Treatment To Stop Electrical Storm In ICD Patients

Background: Electrical storms(ES)after implantable cardioverter defibrillator(ICD)implantation is actually not uncommon,which increases the patients' mortality.Aims: To evaluate the efficacy and safety of multiple ablation approaches supplemented by surgical treatment to stop ES in ICD patients.Methods and Results: Patients who were referred for catheter ablation for ES after ICD implantation in Department of Cardiology in the First Affiliated Hospital of Nanjing Medical University were enrolled in this study and followed up.Procedure details such as approaches,acute success rate and complications were collected.A total of 30 patients were enrolled,with an average age of 49.2±14.4 years old,and 83.3% were male.The proportion of dilated cardiomyopathy,arrthythmogenic right ventricular cardiomyopathy,ischemic cardiomyopathy and normal heart structure was 36.7%,26.7%,6.7% and 13.3%,respectively.Forty-nine procedures were performed in 30 patients.Endocardial,epicardial and endocardial combined with epicardial ablation was performed in 83.3%,60% and 43.3% of patients.Surgical ablation was performed in 6.7% of patients.The proportion of patients who underwent bipolar ablation,intracoronary ethanol ablation,intramural ethanol injection was 3.3% respectively.The acute complete,partial success rate and failure rate of procedure was 55.1%,20.4% and 24.5%.Complications occurred in 3 patients(6.1%),including 1 diaphragmatic paralysis,2 cardiac tamponades and 1 death.After a mean follow-up of 39.7±20.4 months,follow-up was completed in 27 patients,in whom,21 patients(77.8%)survive with transplantation free,and 2 patients(7.4%)received heart transplantation.The incidence of death,VT recurrences,ICD shocks and ES was 14.8%(n=4),37.0%(n=10),29.6%(n=8)and 18.5%(n=10),respectively.Transplantation-free survival rate was 100% in patients with acute complete success in subgroup analysis.Conclusions: Multiple ablation approaches supplemented by surgical treatment is effective and safe.Complete acute success rate is associated with long-term survival rate.