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32. Cardiovascular Nursing
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Early catheter ablation in electrical storm: A propensity score–matched comparison with medical therapy
Session:
Sessão de Comunicações Orais 15 – Instabilidade eléctrica e terapêuticas do sistema de condução: do pacing à tempestade arrítmica
Speaker:
Joana Certo Pereira
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.4 Ventricular Arrhythmias and SCD - Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Rita Almeida Carvalho; Joana Certo Pereira; Ana Rita Bello; Daniel Gomes; João Presume; Daniel Matos; Francisco Costa; Pedro Galvão Santos; Pedro Carmo; Diogo Cavaco; Catarina Brízido; Pedro Adragão
Abstract
<p style="text-align:justify"><strong>Background</strong><br /> <br /> Electrical storm (ES) is a life-threatening arrhythmic emergency whose initial management relies on antiarrhythmic drugs, beta-blockers, sedation, and hemodynamic support. Early catheter ablation (CA) has been proposed to improve outcomes by reducing arrhythmic burden and stabilizing patients. This study aimed to compare CA with medical therapy alone in patients experiencing a first ES episode.<br /> <br /> <strong>Methods</strong><br /> <br /> Single-center, retrospective study including consecutive patients admitted to the cardiac intensive care unit between 2015 and 2025 with a first ES episode, defined as ≥3 episodes of sustained ventricular arrhythmia within 24 hours. Patients were categorized according to management strategy (medical therapy or CA during the index hospitalization) and subsequently matched 1:1 based on age, left ventricular ejection fraction, PAINESD score, creatinine, NT-proBNP, presence of a trigger, and use of sedation, mechanical ventilation, and vasoactive drugs. In the matched cohort, Cox regression was used to estimate hazard ratios (HRs) for time-to-event outcomes: ventricular tachycardia (VT) recurrence and cardiovascular (CV) mortality during follow-up.<br /> <br /> <strong>Results</strong><br /> <br /> A total of 127 patients were included (age 65±14 years; 88% male): 69 (54%) underwent CA and 58 (46%) received medical therapy. Most had ischemic heart disease (59%), followed by non-ischemic cardiomyopathy (39%); 88% presented with monomorphic VT. Medically treated patients more often had acute myocardial infarction (22% vs. 3%, p<0.001), out-of-hospital cardiac arrest (12% vs. 1%, p=0.023), and identifiable triggers (47% vs. 13%, p<0.001). During hospitalization, 33% required continuous sedation, 30% mechanical ventilation, and 26% vasoactive support. Compared with medical therapy, CA patients required less sedation (25% vs. 43%, p=0.044), mechanical ventilation (19% vs. 43%, p=0.005), and vasoactive drugs (17% vs. 36%, p=0.027), suggesting greater early clinical stability. Time to CA was 5 days [3–8], hospital stay 11 days [6–20], and in-hospital mortality 13%. After a median follow-up of 2.1 years [0.4–3.5], CV mortality was 18% and VT recurrence 29%. Before matching, CV mortality was lower with CA (9% vs. 29%, p=0.006) [Figure 1A], while VT recurrence was similar [Figure 1B]. After matching (34 pairs, n=68), CA was associated with lower VT recurrence (HR 0.29, 95% CI 0.07–0.98, p=0.046) [Figure 1D], whereas CV mortality no longer differed significantly (HR 0.38, 95% CI 0.10–1.41, p=0.147) [Figure 1C].<br /> <br /> <strong>Conclusion</strong><br /> ES patients treated medically had greater clinical instability and higher early mortality, reflecting substantial baseline differences between groups. After matching, CA independently predicted lower VT recurrence, suggesting that CA reduces arrhythmic burden, although without evidence of a survival benefit.</p>
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