Clinical Implication of Urgent Catheter Ablation for Refractory Electrical Storm

Catheter ablation for ventricular tachycardia (VT) has historically been challenging due to the high recurrence rate and the relatively high incidence of procedure-related complications such as cardiac tamponade and thromboembolic events, particularly in the previous era when neither contact-force sensing nor irrigated catheters were available. In recent years, however, the threshold for performing catheter ablation has declined owing to major advancements in mapping and ablation technologies. Consequently, an increasing number of centers now perform urgent catheter ablation for patients with electrical storm; nevertheless, the real-world feasibility and efficacy of urgent ablation still remain uncertain. In this retrospective study, the authors demonstrated that the “elective ablation” group showed significantly lower all-cause mortality than the “urgent ablation” group [1]. Several concerns, however, should be raised. The most crucial limitation is the retrospective nature of the study [1]. By definition, patients in the urgent ablation group were those who were refractory to antiarrhythmic drugs and could not be stabilized medically; thus, this group inevitably included patients with more advanced disease and worse hemodynamics. Although statistical adjustment was attempted, the urgent ablation group likely represented patients with higher baseline risk. Consistently, sympathetic blockade procedures were used only in the urgent group, further supporting that those patients were more severely ill at presentation. The recurrence rates of VT after ablation were reported to be comparable between the two groups [1]. We believe this is a meaningful finding. In our previous experience, urgent catheter ablation for refractory VT not only prevented recurrent VT but also facilitated weaning from temporary mechanical circulatory support and avoided device-related complications [2]. Furthermore, patients with electrical storm often require deep sedation and ventilatory support. Early extubation following urgent ablation could reduce the risk of ventilator-associated pneumonia and other iatrogenic complications [3]. Thus, urgent ablation may have an important role in suppressing arrhythmia-related complications during the acute phase. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. The authors have nothing to report.