Impact of ventricular tachycardia ablation in the setting of electrical storm based on patient risk profile

Catheter ablation (CA) plays a central role in the management of electrical storm (ES). PAINESD and iVT are two validated scores commonly used to assess periprocedural risk in patients undergoing ventricular tachycardia (VT) ablation. This study aimed to evaluate the association between CA and mortality in ES patients stratified by PAINESD and iVT risk scores.

We included 606 patients admitted for ES across four French centres. Risk was assessed using PAINESD and iVT scores. Mortality at 1 year was compared according to risk group and CA status. Baseline differences were adjusted using inverse probability of treatment weighting (IPTW) based on predefined clinical variables. Forty-one per cent of patients were classified as high-risk using the PAINESD score, and 39.4% using the iVT score. Catheter ablation was performed in 42.4% of the cohort, including 39.4% of hi-PAINESD and 35.5% of hi-iVT patients. After adjustment, CA was associated with lower 1-year mortality in both high- and low-risk groups (adjusted HR: 0.42 [95% CI: 0.26–0.66], P = 0.0002 for hi-PAINESD; 0.31 [0.18–0.53], P < 0.0001 for hi-iVT). Inverse probability of treatment weighting-weighted models yielded consistent results. In exploratory interaction analyses, the iVT score—but not PAINESD—identified high-risk patients who may derive earlier survival benefit from VT ablation.

In patients with electrical storm, VT ablation was associated with lower 1-year mortality across both low- and high-risk profiles. The iVT score may help identify high-risk patients who derive earlier benefit from ablation.