Perspective:

Electrical storm, an occurrence of at least three distinct episodes of ventricular arrhythmia requiring implantable cardioverter-defibrillator therapy in 24 hours, carries poor prognosis with a mortality rate of 24% at 1 year, with the majority of deaths occurring in the first 3 months. Prior observational cohorts, mostly small single-center series, have shown improved survival in patients treated with catheter ablation compared with medical therapy alone. Randomized clinical trials in this patient population are very difficult to conduct and are therefore lacking. The authors of this analysis pooled data from four referral centers and used propensity score matching to establish whether ablation conferred benefit on survival. Accounting for confounding factors, the use of ablation therapy was associated with a significant reduction in short- and mid-term mortality. The survival benefits associated with ablation were especially large in patients with low LVEF.