Comparison and frequency of ventricular arrhythmias after defibrillator implantation by thoracotomy versus nonthoracotomy approaches

Kim, Soo G.; Ling, Julie; Fisher, John D.; Wang, Gina; Rameneni, Anuradha; Roth, James A.; Ferrick, Kevin J.; Gross, Jay N.; Ben-Zur, Uri; Brodman, Richard; Furman, Seymour

doi:10.1016/0002-9149(94)90556-8

Cited by 20 publications

(4 citation statements)

References 13 publications

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“…Multiple VT episodes early after epicardial or transvenous ICD implantation most probably originate from myocardial irritation. 8,22 VT episodes in the first week after ICD implantation are therefore not included into the strict definition of electrical storm because their mechanism appears different from electrical storm which typically occurs later ICD implantation.…”

Section: Incidence Of Es In Patients With An Icdmentioning

confidence: 99%

Electrical Storm in Patients with an Implanted Defibrillator: A Matter of Definition

Israel

Barold

2007

Noninvasive Electrocardiol

119

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The term "electrical storm" (ES) indicates a state of cardiac electrical instability manifested by several episodes of ventricular tachyarrhythmias (VTs) within a short time. In patients with an implantable cardioverter defibrillator (ICD), ES is best defined as 3 appropriate VT detections in 24 h, treated by antitachycardia pacing, shock or eventually untreated but sustained in a VT monitoring zone. The number of shocks and inappropriate detections are irrelevant for the definition. ES occurs in approximately 25% of ICD patients within 3 years, with typically 5-55 individual VTs within one storm. Potential triggers can be found in approximately 66% of patients and include new/worsened heart failure, changes in antiarrhythmic medication, context with other illness, psychological stress, diarrhea, and hypokalemia. In most patients, ES consists of monomorphic VT indicating the presence of reentry while ventricular fibrillation indicating acute ischemia is rare. ES seems to have a low immediate mortality (1%) but frequently (50-80%) leads to hospitalization. Long-term prognostic implications of ES are unclear. The key intervention in ES is reduction of the elevated sympathetic tone by beta blockers and frequently benzodiazepines. Amiodarone i.v. has also been successful and azimilide seems promising while class I antiarrhythmic drugs are usually unsuccessful. Substrate mapping and VT ablation may be useful in treatment and prevention of ES. Prevention of ES requires ICD programming systematically avoiding unnecessary shocks (long VT detection, antitachycardia pacing where ever possible) which otherwise can fuel the sympathetic tone and prolong ES.

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Section: Incidence Of Es In Patients With An Icdmentioning

confidence: 99%

Electrical Storm in Patients with an Implanted Defibrillator: A Matter of Definition

Israel

Barold

2007

Noninvasive Electrocardiol

119

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“…However, some patients receive multiple appropriate shocks during a short period due to recurrent or incessant ventricular tachycardia (VT), a condition known as arrhythmic storm. The incidence of this event ranges between 3.3% and 26.6%, according to published data 5–14 . Antiarrhythmic drugs, sedation with midazolam, or VVI stimulation using an ICD have been used to treat this condition with limited success 8,11,15,16 ; many patients need additional measures to control their arrhythmic episodes.…”

Section: Introductionmentioning

confidence: 99%

Radiofrequency Catheter Ablation for Arrhythmic Storm in Patients with An Implantable Cardioverter Defibrillator

Silva

Mont

Nava

et al. 2004

Pacing Clinical Electrophis

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The aim of the study was to analyze the usefulness of RFA in controlling arrhythmic storm due to hemodynamically stable VT in a cohort of patients with an ICD and to evaluate the incidence of arrhythmic storm among patients with an ICD. A group of 13 (3%) of 403 consecutive ICD recipients were submitted to RFA of VT during an arrhythmic storm. Two additional patients were referred from other institutions. Standard criteria were used for VT endocardial ablation. A transcatheter epicardial approach was required in three patients. A total of 18 procedures were performed in 15 patients. A mean of 13.2 +/- 9.7 pulses of RF were delivered. Clinical tachycardia was successfully ablated in 12 (80%) patients. One patient died in incessant VT, 1 patient underwent heart transplant, and 1 was treated with direct current ablation. During a mean follow-up of 12 +/- 17 months, only two patients suffered a single episode of VT. Arrhythmic storm requiring VT ablation was uncommon among patients with an ICD and occurred late after ICD implantation. The arrhythmic episode was successfully controlled in the majority of patients with endocardial or epicardial RFA.

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“…Depending on the definitions used and in the populations assessed, there is a great variability in the incidence of VA storms reported in various studies. An early study suggested an approximately 20% incidence in patients during the first few days following implantation of ICD 13. However, this electrical instability that arises early following ICD implantation was thought to be the result of irritation and is not strictly interpreted as VA storm 14…”

Section: Incidence and Predictors Of Ventricular Arrhythmia Stormmentioning

confidence: 99%

Ventricular arrhythmia storm in the era of implantable cardioverter-defibrillator

Looi

Tang

Agarwal

2015

Postgraduate Medical Journal

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In the era of widespread use of implantable cardioverter-defibrillators (ICDs) for both primary and secondary prevention of sudden cardiac death, a significant proportion of patients experience episodes of multiple ventricular tachycardia/fibrillation over a short period of time requiring device interventions. The episodes are termed ventricular arrhythmia (VA) or electrical storms. VA storm is a tragic experience for patients, with many psychological consequences. Current management for VA storms remains complex. Acutely, administration of β-blockers, amiodarone and sedation or intubation is generally required to suppress sympathetic tone. Interventional treatment includes catheter ablation and sympathetic blockade by left cardiac sympathetic denervation. Strategies to modify autonomic tone to suppress VAs are the rationale of various novel interventions that have been published in recent studies. All patients with VA storm should be considered for transfer to an experienced high-volume tertiary centre for evaluation and treatment to prevent further recurrence of VA storm.

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Comparison and frequency of ventricular arrhythmias after defibrillator implantation by thoracotomy versus nonthoracotomy approaches

Cited by 20 publications

References 13 publications

Electrical Storm in Patients with an Implanted Defibrillator: A Matter of Definition

Electrical Storm in Patients with an Implanted Defibrillator: A Matter of Definition

Radiofrequency Catheter Ablation for Arrhythmic Storm in Patients with An Implantable Cardioverter Defibrillator

Ventricular arrhythmia storm in the era of implantable cardioverter-defibrillator

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