Treating Electrical Storm

Nademanee, Koonlawee; Taylor, Richard N.; Bailey, W. E.; Rieders, Daniel; Kosar, Erol M.

doi:10.1161/01.cir.102.7.742

Cited by 415 publications

(110 citation statements)

References 22 publications

Supporting

Mentioning

108

Contrasting

Order By: Relevance

“…96 The report of sympathetic blockade in humans compared survival in a group of 49 patients with recurrent ventricular fibrillation (electrical storm) early after MI treated with standard advanced cardiac life support (ACLS) protocol vs sympathetic blockade. 97 Sympathetic blockade was established using left stellate ganglionic blockade in 6 patients and infusions of either propranolol or esmolol in 21 patients without antiarrhythmic therapy as recommended by ACLS. The 1-week and 1-year mortality were significantly higher in the group undergoing standard ACLS protocol, compared with the sympathetic blockade group (82% vs 22% at 1 week, 95% vs 33% at 1 year, respectively).…”

Section: Selective Sympathetic Blockadementioning

confidence: 99%

“…The 1-week and 1-year mortality were significantly higher in the group undergoing standard ACLS protocol, compared with the sympathetic blockade group (82% vs 22% at 1 week, 95% vs 33% at 1 year, respectively). 97 Successful treatment of recurrent ventricular tachycardia, refractory to antiarrhythmic therapy, can be achieved by neuraxial modulation at the level of the spinal cord. The benefit of thoracic epicardial anesthesia was reported in a patient with ischemic cardiomyopathy and recurrent ventricular arrhythmia refractory to intubation and sedation, with the use of 0.25% Bupicavaine at T1-T2 interspace, reducing the number of ICD shocks from 86 in 48 hours to zero.…”

Section: Selective Sympathetic Blockadementioning

confidence: 99%

See 1 more Smart Citation

The Role of the Autonomic Nervous System in Sudden Cardiac Death

Vaseghi

Shivkumar²

2008

Progress in Cardiovascular Diseases

328

233

View full text Add to dashboard Cite

The cardiac autonomic nervous system consists of 2 branches-the sympathetic and the parasympathetic systems-that work in a delicately tuned, yet opposing fashion in the heart. This extrinsic control mechanism can dominate intrinsic regulatory mechanisms that modulate heart rate and cardiac output. These branches differ in their neurotransmitters (norepinephrine and acetylcholine) and exert stimulatory or inhibitory effects on target tissue via adrenergic and muscarinic receptors. Stimulation of the sympathetic branch exerts facilitatory effects on function, increasing heart rate and myocardial contractility, whereas the stimulation of the parasympathetic branch exerts inhibitory effects that decrease heart rate and contractility. The interplay between these two branches is complex and susceptible to control at several levels, from centrally mediated baroreceptors and chemoreceptors to local interneuronal interactions.Alterations in autonomic function occur in several interrelated cardiac conditions including sudden cardiac death, congestive heart failure, diabetic neuropathy, and myocardial ischemia. Although the full extent of these changes has not been elucidated, multiple autonomic remodeling mechanisms have been observed at both the neuronal fiber and myocardial cellular level that contribute to an arrhythmogenic substrate. We describe the anatomy of both systems in this review. However, the review will premdominantly focus on the sympathetic system, whose role in the modulation of cardiac arrhythmias is slightly better delineated. Cardiac Autonomic Innervation: NeuroanatomyBoth branches of the autonomic nervous system are composed of both afferent and efferent as well interneuronal fibers (Fig 1). Sympathetic innervation originates mainly in the right and left stellate ganglia. These fibers travel along the epicardial vascular structures of the heart and penetrate into the underlying myocardium similar to coronary vessels and end as sympathetic nerve terminals reaching the endocardium. Based on norepinephrine content studies, a gradient exists in sympathetic innervation from atria to the ventricles and from base to apex of the heart. Therefore, the atria are most densely innervated, but the ventricles are also supplied with a sympathetic network, most densely at the base. 1 Parasympathetic effects are carried by the right and left vagus nerves, originating in the medulla. The vagus nerve further divides into the superior and inferior cardiac nerves, finally merging with the postganglionic sympathetic neurons to form a plexus of nerves at the base of the heart, known as the cardiac plexus. In contrast to sympathetic neurons, after parasympathetic fibers cross the atrioventricular (AV) groove along the surface of the heart,

show abstract

Section: Selective Sympathetic Blockadementioning

confidence: 99%

Section: Selective Sympathetic Blockadementioning

confidence: 99%

The Role of the Autonomic Nervous System in Sudden Cardiac Death

Vaseghi

Shivkumar²

2008

Progress in Cardiovascular Diseases

328

233

View full text Add to dashboard Cite

show abstract

“…Intravenous β-blockers to suppress adrenergic stimulation, intubation and sedation, anti-ischemic therapy, intra-aortic balloon pump and ventricular assist devices for hemodynamic support have been used to suppress the ventricular arrhythmias. The ICD can be interrogated to ascertain programmed parameters to attempt pace termination of VT. Catheter ablation of VT/VF may be used as a last treatment way in selected patients [3,32,33]. …”

Section: Electrical Stormmentioning

confidence: 99%

Emergencies of Implantable Cardioverter Defibrillator

Buğan¹

2012

Current Issues and Recent Advances in Pacemaker Therapy

View full text Add to dashboard Cite

“…ES complicating acute coronary syndrome most often occurs in the first 48 h and it has a high mortality rate exceeding 50% in patients with ST-segment elevation infarction [16].…”

Section: Pathomechanismmentioning

confidence: 99%

“…One paper has reported a more effective sympathetic blockade using stellate ganglionic blockade [16].…”

Section: Figmentioning

confidence: 99%

Intensive management of electrical storm and incessant ventricular arrhythmias

Zima

2011

IMAS

View full text Add to dashboard Cite

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.

show abstract

Treating Electrical Storm

Cited by 415 publications

References 22 publications

The Role of the Autonomic Nervous System in Sudden Cardiac Death

The Role of the Autonomic Nervous System in Sudden Cardiac Death

Emergencies of Implantable Cardioverter Defibrillator

Intensive management of electrical storm and incessant ventricular arrhythmias

Contact Info

Product

Resources

About