Catheter Ablation Versus Medical Therapy as First-Line Treatment for Ventricular Electrical Storm: A Systematic Review and Meta-Analysis
Author Department
Cardiology; Medicine
Document Type
Article, Peer-reviewed
Publication Date
12-2025
Abstract
Background: Electrical storm (ES) is a life-threatening manifestation of recurrent ventricular arrhythmia. While anti-arrhythmic drugs (AADs) have historically been the first-line treatment, the role of catheter ablation (CA) as an initial therapy in ES remains incompletely defined. This meta-analysis evaluates the efficacy and safety of radiofrequency CA compared to escalating medical therapy in patients with ES.
Methods: A systematic search of PubMed, Science Direct, and Cochrane databases was conducted for studies published from 2010 to 2025 that compared CA with medical therapy as first-line treatment for ES. Outcomes of interest included ES recurrence, ventricular arrhythmia recurrence, in-hospital mortality, procedural complications, and follow-up survival. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models.
Results: Six studies encompassing 963 patients (473 CA, 490 medical therapy) were included. The mean age was 67.8 years, and 87.7% were male. The mean left ventricular ejection fraction was 33%, and ischemic cardiomyopathy was present in 77.5% of CA and 72.1% of MT patients. CA reduced the risk of ES recurrence by 71% compared to medical therapy (OR: 0.29; 95% CI: 0.15-0.53; p < 0.001; I² = 53%). Recurrence of any ventricular arrhythmia, in-hospital mortality, and long-term survival were also significantly improved with CA.
Conclusion: This meta-analysis suggests that CA is associated with lower ES and VA recurrence and in-hospital mortality and improved survival compared to medical therapy alone. These findings support consideration of catheter ablation as a first-line strategy. Larger prospective trials are needed to confirm these findings and guide patient selection.
Keywords: catheter ablation; electrical storm; outcomes; ventricular arrhythmia; ventricular tachycardia.
Recommended Citation
Sawalha K, Kusumoto F, Al-Akchar M, Sadeq A, Goldsweig AM. Catheter Ablation Versus Medical Therapy as First-Line Treatment for Ventricular Electrical Storm: A Systematic Review and Meta-Analysis. J Cardiovasc Electrophysiol. 2025 Dec 8. doi: 10.1111/jce.70222. Epub ahead of print.
PMID
41361845