Electrical Storm: Current Evidence, Clinical Implications, and Future Perspectives

Kontogiannis, Christos; Tampakis, Konstantinos; Georgiopoulos, Georgios; Bartoletti, Stefano; Papageorgiou, Christos; Anninos, Hector; Kapelouzou, Alkistis; Spartalis, Μichael; Paraskevaidis, Ioannis; Chatzidou, Sofia

doi:10.1007/s11886-019-1190-0

Cited by 10 publications

(10 citation statements)

References 59 publications

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“…In our demonstrated case, the treatment of the electrical storm was performed according to current guideline recommendations and included a drug therapy: anti-arrhythmic pharmacotherapy was a combination of ß-blocker administration and amiodarone [ 20 , 21 ]. As electrical storm is mostly observed in patients with ischemic heart disease and either is triggered by myocardial ischemia or occurs on the basis of scars as substrate; guidelines also recommend an urgent revascularization [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…This, however, did not terminate the VT in our patient. Subsequent catheter ablation as part of our therapeutic approach in accordance with current recommendations finally stopped the recurrent episodes of electrical storm [ 9 , 20 , 21 ]. In theory, cardiac magnetic resonance imaging (MRI) to identify substrates for catheter ablation may increase ablation success.…”

Section: Discussionmentioning

confidence: 99%

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Effective treatment of electrical storm by a wearable cardioverter defibrillator in a patient with severely impaired left ventricular function after myocardial infarction: a case report

Andresen¹,

Sasko²,

Patschan³

et al. 2021

J Med Case Reports

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Background The implantation of cardioverter defibrillators (ICDs) is an established therapy in the prevention of sudden cardiac death in patients with systolic dysfunction after myocardial infarction. To avoid immediate implantation of an ICD, wearable cardioverter defibrillator vests (WCD) can be used to protect patients against malignant rhythm disorders, while at the same time drug-based heart failure therapy has to be initiated. This drug therapy can improve left ventricular ejection fraction and primary prophylactic cardioverter defibrillator implantation may not be necessary. However, the recent Vest Prevention of Early Sudden Death Trial (VEST) questioned the regular use of the WCD in this setting. Case presentation A 47-year-old Caucasian man with severely impaired left ventricular function early after myocardial infarction was prescribed a WCD as primary prophylaxis to prevent sudden cardiac death. Seven days after the patient was supplied with a WCD, the patient suffered from an electrical storm with recurrent ventricular tachycardia (VT), which was successfully terminated 17 times by the WCD. On coronary angiography, the formerly infarct-related right coronary artery had TIMI (Thrombolysis in Myocardial Ischemia Trial) III flow, and a remaining stenosis in the left anterior descending artery (LAD) was stented, which did not stop recurrent VT. In the electrophysiology (EP) study, a focus was mapped in the left inferior ventricle, which was ablated. This stopped the VT. A second radio-frequency (RF) ablation in the same area was necessary after 14 days. Finally, a permanent cardioverter defibrillator was implanted. Conclusion We report the case of a patient who survived recurrent episodes of VT early after myocardial infarction by effective defibrillation with a WCD. The WCD is a useful device to bridge time until a final decision for implantation of a defibrillator.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effective treatment of electrical storm by a wearable cardioverter defibrillator in a patient with severely impaired left ventricular function after myocardial infarction: a case report

Andresen¹,

Sasko²,

Patschan³

et al. 2021

J Med Case Reports

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“…In contrast, interventional procedures are increasingly implemented in refractory forms of ES. Catheter ablation of the VT/VF focal substrate ( 9 , 10 ), stellate ganglionic blockade, and bilateral cardiac sympathetic denervation ( 10 ) may reduce the incessant recurrences of ventricular arrhythmia resistant to standard antiarrhythmic treatment and improve short-term outcomes and survival. Recently, renal artery denervation has emerged as a promising adjunctive therapy for refractory VT/VF events in patients with underlying cardiomyopathy ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

A Recalcitrant Electrical Storm and Implantable Defibrillator Exhaustion

et al. 2019

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A 60-year-old patient presented with recalcitrant electrical storm (ES). Mild sedation and initial antiarrhythmic combination of esmolol and amiodarone did not affect the intensity of ES, which resulted in battery exhaustion. Oral propranolol in addition to intravenous amiodarone might be preferred in hemodynamically stable patients before interventional therapies. ( Level of Difficulty: Intermediate. )

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“…In a post hoc study of SCDHeFT, it was discovered that ICD shocks, whether appropriate or not, were correlated with a lower rate of survival in ICD patients [58][59][60]. Much research has shown that shocks can be minimized by proper programming, which allows for longer detections and durations before shock initiation [60]. Furthermore, a randomized trial (MADIT-RIT) demonstrated that such programming is correlated with increased patient survival [60].…”

Section: Novel Concepts In Defibrillator Therapy In Hfmentioning

confidence: 99%

Contemporary ICD Use in Patients with Heart Failure

et al. 2021

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Despite constant breakthroughs in heart failure (HF) therapy, the population of HF patients resume to grow and is linked to increased mortality and morbidity. Ventricular arrhythmias (VA) are one of the leading causes of mortality in HF subjects. Implantable cardioverter-defibrillators (ICDs) are currently the gold standard in treatment, preventing arrhythmic sudden cardiac death (SCD) episodes. However, the death rates related to HF remain elevated, as not all HF subjects benefit equally. Cardiac resynchronization therapy (CRT) has emerged as a novel approach for HF patients. These devices have been thoroughly investigated in major randomized controlled studies but continue to be underutilized in various countries. This review discusses the use of ICD in HF populations on top of treatments.

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Electrical Storm: Current Evidence, Clinical Implications, and Future Perspectives

Cited by 10 publications

References 59 publications

Effective treatment of electrical storm by a wearable cardioverter defibrillator in a patient with severely impaired left ventricular function after myocardial infarction: a case report

Effective treatment of electrical storm by a wearable cardioverter defibrillator in a patient with severely impaired left ventricular function after myocardial infarction: a case report

A Recalcitrant Electrical Storm and Implantable Defibrillator Exhaustion

Contemporary ICD Use in Patients with Heart Failure

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