Cardiac resynchronization therapy and electrical storm: results of the OBSERVational registry on long-term outcome of ICD patients (OBSERVO-ICD)

Guerra, Federico; Palmisano, Pietro; Dell’Era, Gabriele; Ziacchi, Matteo; Ammendola, Ernesto; Pongetti, Giulia; Bonelli, P.; Patani, Francesca; Devecchi, Chiara; Accogli, Michele; Occhetta, Eraldo; Nigro, Gerardo; Biffi, Mauro; Boriani, Giuseppe; Capucci, Alessandro; Pacing, Cardiac

doi:10.1093/europace/eux166

Cited by 28 publications

(25 citation statements)

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“…It is conceivable that triggering of the arrhythmic episode might have been influenced by other factors such as impaired left ventricular function and the potentially pro-arrhythmic nature of CRT-D itself [8]. However, the fact that the patient was a super CRT-D responder along with the event-free period of nine consecutive years after the device implantation was evidence against these factors having a primary role in triggering the electrical storm [9]; although this cannot be ruled out completely.…”

Section: Discussionmentioning

confidence: 99%

Anomalous right coronary artery with interarterial course depicting an unusual case of an electrical storm: a case presentation

Pradhan

Gresa

Trappe

2020

BMC Cardiovasc Disord

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Background: The condition of anomalous aortic origin of the right coronary artery (AAORCA) with an interarterial course leads to few, if any, clinical problems. Malignant presentation of the often non-significant AAORCA associated with conduction system abnormalities is a rare finding. Surgical repair, even for highly symptomatic patients, is still controversial. However, in this case, the surgery brought a paradigm shift in treatment modality, improving the symptoms of this patient. Case presentation: We report a case of a 52-year-old man with severe chest pain and recurrent electrical storms with an implanted cardiac resynchronization therapy defibrillator (CRT-D) device. Coronary angiography and computed tomography (CT) revealed the rare anomalous aortic origin of the right coronary artery (AAORCA) with a high interarterial course between the aorta and the pulmonary trunk. As symptoms typically develop on exertion, placing the patient at an increased risk of ischemic distress, a stress myocardial perfusion imaging study helped to identify his high-risk status. Although patient-specific, a surgical repair was the only concrete step agreed upon after multiple collaborative discussions with the cardiac surgeons. Surgery significantly improved the symptoms, with the patient reporting resolution of his chest pain, as well as no documented inappropriate defibrillator activity on follow-up appointments. Conclusion: One purpose of reporting the case study was to underscore the risk factors associated with AAORCA, challenging claims of its benign nature. This case complements existing findings demonstrating that ischemic distress consequent to the right coronary artery (RCA) compression may precede the rare incidence of an electrical storm. Importantly, the case-study emphasizes the significance of integrated multimodality imaging in clinical practice as well as providing real-world evidence for the efficacy of surgical repair in highly symptomatic patients with AAORCA with an interarterial course.

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Section: Discussionmentioning

confidence: 99%

Anomalous right coronary artery with interarterial course depicting an unusual case of an electrical storm: a case presentation

Pradhan

Gresa

Trappe

2020

BMC Cardiovasc Disord

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“…In primary prevention patients the incidence of ES reaches about 4% [12, 14, 15] and in secondary prevention 10–40% [6, 7]. Only a few analyses comparing the incidence of ES in patients with ICD and CRT-D have been performed [15–17]. The prevalence of ES in ICD vs. CRT-D groups was 7% vs. 0.6%, respectively, even though patients with CRT-D had significantly lower mean left ventricular ejection fraction (LVEF) when compared with ICD patients (21.7 ±11% vs. 34 ±15%) [15].…”

Section: Definition and Epidemiologymentioning

confidence: 99%

“…This difference was explained by the beneficial influence of resynchronization therapy on the reverse modelling of the left ventricle [16]. Guerra et al found that patients with CRT had a lower incidence of ES compared with propensity-matched ICD patients (5.6% vs. 12.3%) and CRT-D was associated with a 45% relative risk reduction in ES compared with ICD [17].…”

Section: Definition and Epidemiologymentioning

confidence: 99%

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Electrical storm – still an extremely poor prognosis. Do these acute states of life-threatening arrhythmias require a multidirectional approach from the start?

Gadula‐Gacek

Tajstra

Gąsior

2019

pwki

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Electrical storm (ES) is a state of electrical instability of the heart manifesting as multiple and potentially lethal recurring ventricular arrhythmias such as ventricular tachycardia or ventricular fibrillation. This definition is not related to the condition of each patient, who can present from asymptomatic to unconscious and in deep cardiogenic shock. Most patients affected by ES have heart failure (HF) of ischaemic origin. Ischaemia, exacerbation of HF, low ejection fraction, previous ventricular arrhythmias, infection or electrolyte disturbances together with other factors, or a few factors combined, may result in ES. The prognosis of ES survivors is very poor, with 1-year mortality exceeding 40%, which should draw attention to this group of patients as one of extremely high risk. The number of patients with cardioverter-defibrillators is increasing and so is the number of patients suffering from ES. Therefore, each patient should be supported with tailored therapy, and not only restricted to pharmacotherapy or ablation procedures. This paper was written to analyse the most frequent causes of ES and prompt the most appropriate clinical pathways and possibilities, underlining the need for a comprehensive invasive approach to diagnosis, treatment and circulatory stabilization in addition to adequate pharmacotherapy. This approach might help to reduce the mortality rate in this group of patients and improve the prognosis.

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“…In these patients, CRT has been demonstrated to reduce all-cause mortality [ 53 , 58 ] and HF hospitalization [ 59 , 60 ] ( Table 2 ), while reducing left ventricular volumes, increasing left ventricular ejection fraction, and improving NYHA class, 6-minute walking test, quality of life, and peak oxygen consumption [ 61 ]. Moreover, clinical and echographic response to CRT seems to reduce clustered and unclustered ventricular arrhythmias in a recent propensity-score matched analysis [ 62 ].…”

Section: Cardiac Resynchronization Therapy (Crt)mentioning

confidence: 99%

Current Therapeutic Options for Heart Failure in Elderly Patients

Guerra

Brambatti

Matassini

et al. 2017

BioMed Research International

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Heart failure (HF) is a major and growing public health problem with high morbidity and mortality (Ponikowski et al., 2016). It affects 1-2% of the general population in developed countries, and the average age at diagnosis is 76 years. Because of a better management of acute phase and comorbidities, HF incidence is increasing in elderly patients, with a prevalence rising to 10% among people aged 65 years or older (Mozaffarian et al., 2014). Therefore, a substantial number of elderly patients need to be treated. However, because of clinical trial exclusion criteria or coexisting comorbidities, currently recommended therapies are widely based on younger population with a much lower mean age. In this review, we will focus on available pharmacological, electrical, and mechanical therapies, underlining pros, cons, and practical considerations of their use in this specific patient population.

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Cardiac resynchronization therapy and electrical storm: results of the OBSERVational registry on long-term outcome of ICD patients (OBSERVO-ICD)

Abstract: Patients with CRT had a lower incidence of ES when compared with propensity-matched ICD patients. The long-term benefit of CRT seems to be due to the improved haemodynamics, as CRT-responders performed markedly better over a long-term follow-up.

Cited by 28 publications

References 20 publications

Anomalous right coronary artery with interarterial course depicting an unusual case of an electrical storm: a case presentation

Anomalous right coronary artery with interarterial course depicting an unusual case of an electrical storm: a case presentation

Electrical storm – still an extremely poor prognosis. Do these acute states of life-threatening arrhythmias require a multidirectional approach from the start?

Current Therapeutic Options for Heart Failure in Elderly Patients

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