Incidence and Clinical Significance of Multiple Consecutive, Appropriate, High-Energy Discharges in Patients With Implanted Cardioverter-Defibrillators

Pérez-Villacastín, Julián; Almendral, Jesús; Arenal, Ángel; Albertos, J; Ormaetxe, José; Peinado, Rafaél; Bueno, Héctor; Merino, José Luís; Pastor, A. García; Medina, Olga; Tercedor, Luís; Jiménez, Francisco López; Delcán, Juan L.

doi:10.1161/01.cir.93.4.753

Cited by 126 publications

(97 citation statements)

References 61 publications

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“…[1][2][3] More specifically, electrical storm (ES), characterized by very frequent arrhythmic episodes resulting in appropriate ICD shocks, 4 is a frightening event associated with poor short-and long-term prognoses. [5][6][7][8][9][10][11][12][13][14] Although radiofrequency catheter ablation (CA) has an established role in the treatment of recurrent VT, 4,15 its value in patients with ES has been investigated only in selected series as a bailout therapy. 16 -18 …”

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confidence: 99%

Catheter Ablation for the Treatment of Electrical Storm in Patients With Implantable Cardioverter-Defibrillators

et al. 2008

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Background-Electrical storm (ES) caused by recurrent episodes of ventricular tachycardia (VT) can cause sudden death in patients with implantable cardioverter-defibrillators and adversely affects prognosis in survivors. Catheter ablation has been proposed for treating ES, but its long-term effect in a large population has never been verified. Methods and Results-Ninety-five consecutive patients with coronary artery disease (72 patients), idiopathic dilated cardiomyopathy (10 patients), and arrhythmogenic right ventricular dysplasia/cardiomyopathy (13 patients) undergoing catheter ablation for drug-refractory ES were prospectively evaluated. Short-term efficacy was defined by a complete protocol of programmed electric stimulation and by in-hospital outcome; long-term analysis addressed ES recurrence, cardiac mortality, and VT recurrence. Pleomorphic/nontolerated VTs required electroanatomic and noncontact mapping in 48 and 22 patients, respectively, and percutaneous cardiopulmonary support in 10 patients. An epicardial approach was used in 10 patients. After 1 to 3 procedures, induction of any clinical VT(s) by programmed electrical stimulation was prevented in 85 patients (89%). ES was acutely suppressed in all patients; a minimum period of 7 days with stable rhythm was required before hospital discharge. At a median follow-up of 22 months (range, 1 to 43 months), 87 patients (92%) were free of ES and 63 patients (66%) were free of VT recurrence. Eight of 10 patients with persistent inducibility of clinical VT(s) had ES recurrence; 4 of them died suddenly despite appropriate implantable cardioverter-defibrillator intervention. All together, 11 of 95 patients (12%) died of cardiac-related reasons. In the group of patients presenting with all clinical VTs acutely abolished, no ES recurrence was documented, and cardiac mortality was significantly lower compared with the group of patients showing Ն1 clinical VT still inducible after catheter ablation. Conclusions-Advanced strategies of catheter ablation applied to a large population of patients are effective in the short-term treatment of ES. By preventing ES recurrence, catheter ablation may play a protective role over the long term and, together with long-term pharmacological therapy, may favorably affect cardiac mortality. (Circulation. 2008;117: 462-469.)

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Catheter Ablation for the Treatment of Electrical Storm in Patients With Implantable Cardioverter-Defibrillators

et al. 2008

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“…[33][34][35] Although, recent clinical trials have suggested role of catheter ablation techniques as a first line treatment for electrical storm, antiarrhythmic drugs still remain the cornerstone for the therapy for electrical storm. Reversal of precipitating factors, optimization of β-blocker therapy and addition of intravenous amiodarone followed by oral maintenance dosing is required in most cases to abort and prevent recurrent ventricular arrhythmia.…”

Section: Benefits Of Adjuvant Antiarrhythmic Drug Therapymentioning

confidence: 99%

Role of Antiarrhythmic Drugs: Frequent Implantable Cardioverter-Defibrillator Shocks, Risk of Proarrhythmia, and New Drug Therapy

Droogan

Patel

Yan

et al. 2011

Heart Failure Clinics

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“…The most often causes in the background of 20% of ES are electrolyte disorders, stress or unexpected proarrhythmia caused by antiarrhythmic agents [11,13,21,22].…”

Section: Pathomechanismmentioning

confidence: 99%

Intensive management of electrical storm and incessant ventricular arrhythmias

Zima

2011

IMAS

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Electrical storm (ES) is defined as ventricular tachycardia or ventricular fibrillation occurring at least three times in 24 h leading to hemodynamic unstable state that needs cardioversion or defibrillation. ES may cause fast hemodynamic impairment, leading to “low-perfusion” or “no perfusion” state of the organs, a vicious circle pointing toward cardiogenic shock, multi-organ failure, and pulseless electrical activity. ES in ICD patients may be a strong predictor of arrhythmic and nonarrhythmic death, as well as of rehospitalization. The first step is to start cardiopulmonary resuscitation to achieve complete hemodynamic stabilization to prevent the low-flow or no-flow state. The patient has to be transported to an intensive care unit for further specific treatment. The arrhythmia should be treated with specific antiarrhythmic agents, for example, amiodarone, lidocain and bretylium, and then all the reversible causes have to be detected and treated as fast as possible. Underlying heart disease determines the specific treatment such as coronary revascularization, mechanical circulatory and respiratory support, and ablation of the arrhythmic foci.

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Incidence and Clinical Significance of Multiple Consecutive, Appropriate, High-Energy Discharges in Patients With Implanted Cardioverter-Defibrillators

Cited by 126 publications

References 61 publications

Catheter Ablation for the Treatment of Electrical Storm in Patients With Implantable Cardioverter-Defibrillators

Catheter Ablation for the Treatment of Electrical Storm in Patients With Implantable Cardioverter-Defibrillators

Role of Antiarrhythmic Drugs: Frequent Implantable Cardioverter-Defibrillator Shocks, Risk of Proarrhythmia, and New Drug Therapy

Intensive management of electrical storm and incessant ventricular arrhythmias

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