Kusumoto, Fred

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; I ² = 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.

This case report describes a woman in her early 60s who went into cardiac arrest immediately after administration of an echocardiogram contrast agent.

Background: Atypical Atrial Flutter (AAFL) prevalence is increasing due to the escalating Atrial Fibrillation (AF) ablations and cardiac surgeries. We wanted to explore the outcome of the AAFL ablation, considering the recent changes in mapping and ablation. Methods: This study was approved by the Institutional Review Board (IRB) of Mayo Clinic hospital. We retrospectively studied 419 patients who had undergone AAFL ablation at Mayo Clinic from January 2017 to June 2022. Thirteen patients declined research authorization, and 19 patients were lost to follow-up during the 90-day blanking period, resulting in a sample size of 387. The median follow-up time for patients was 25.7 months (95% CI 23.7, 32.3). Results: Recurrent symptoms with documentation of atrial arrhythmia Occurred in 226/387 (58.4%) patients, of which 151/226 (66.8%) occurred within the first year. The median time to recurrence was 8.5 months (max 57.8 months). Eleven patients died during the study period, 9 of whom experienced recurrence prior to death. Overall, the median recurrence-free survival (RFS) time was 16.6 months (95% CI 13.2, 20.0) with a 1-year RFS rate of 57.2% (95% CI 52.2, 62.7%). Acute termination occurred 324/387 (83.7%) during the ablation. The 1-year RFS rate was 58.9% (95% CI 53.5%, 64.9%) for patients with acute termination and 49.0% (95% CI 37.9%, 63.4%) for those without acute termination. The rate was not significantly different based on acute termination status (p = 0.11). Conclusions: The one-year RFS rate of 57.2% following AAFL ablation, even though 83.7% achieved acute termination during the procedure, signifies the extent of the underlying substrate abnormalities.