Electrical Storm Presages Nonsudden Death

Exner, Derek V.; Pinski, Sergio L.; Wyse, D. George; Renfroe, Ellen Graham; Follmann, Dean; Gold, Michael R.; Beckman, Karen J.; Coromilas, James; Lancaster, Scott; Hallstrom, Alfred P.

doi:10.1161/01.cir.103.16.2066

Cited by 337 publications

(113 citation statements)

References 40 publications

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“…The relevant report from the Antiarrhythmics Versus Implantable Defibrillators trial involved secondary prevention with focus on ICD therapy for electrical storm. 13 The development of Values are 1-year mortality rates derived from Kaplan-Meier cumulative probability of type-specific mortality, with P value for all-cause mortality from the log-rank statistic comparing the 3 groups. Data on the subtypes of death were not subjected to statistical tests owing to overlap with all-cause mortality or small numbers of deaths.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Clinical Course of Patients After Termination of Ventricular Tachyarrhythmia by an Implanted Defibrillator

et al. 2004

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Background-The implanted cardioverter defibrillator (ICD) improves survival in high-risk cardiac patients. This analysis from the MADIT-II trial database examines the long-term clinical course and subsequent mortality risk of patients after termination of life-threatening ventricular tachyarrhythmias by an ICD. Methods and Results-Life-table survival analysis was performed, and proportional hazards regression analysis was used to evaluate the contribution of baseline clinical factors and time-dependent defibrillator therapy to mortality during long-term follow-up. Of 720 patients with an ICD (average follow-up 21 months), 169 patients received 701 antiarrhythmic device therapies for ventricular tachyarrhythmias. Few baseline characteristics distinguished patients who received appropriate ICD therapy for their first ventricular tachyarrhythmic episode. The probability of survival for at least 1 year after first therapy for ventricular tachycardia (VT) or ventricular fibrillation (VF) was 80%. The hazard ratios for the risk of death due to any cause in those who survived appropriate therapy for termination of VT and VF were 3.4 (PϽ0.001) and 3.3 (Pϭ0.01), respectively, compared with those who survived without receiving ICD therapy, with a high frequency of heart failure and late nonsudden cardiac death after first successful ICD therapy for VF. Conclusions-Successful appropriate therapy by an ICD for VT or VF is associated with 80% survival at 1 year after arrhythmia termination. These patients are at increased risk for heart failure and nonsudden cardiac death after device termination of VT or VF and should receive special attention for the prevention and management of progressive left ventricular dysfunction during long-term follow-up.

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Section: Discussionmentioning

confidence: 99%

Long-Term Clinical Course of Patients After Termination of Ventricular Tachyarrhythmia by an Implanted Defibrillator

et al. 2004

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“…Although management of these patients is difficult, ICD storm has not uniformly been demonstrated to confer increased mortality on the patients who experience it. 14,15 Precipitating factors for electrical storm are rarely identified. 14 Possible causes include hypokalemia, hypomagnesemia, acute myocardial infarction or other ischemic syndrome, proarrhythmia from antiarrhythmic drugs, and torsade de pointes secondary to a prolonged QT interval.…”

Section: Definition and Incidence Of Icd Stormmentioning

confidence: 99%

Understanding implantable cardioverter defibrillator shocks and storms: Medical and psychosocial considerations for research and clinical care

Sears¹,

Conti²

2003

Clinical Cardiology

150

111

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Summary:The experience of shock is the distinguishing feature for patients with implantable cardioverter defibrillators (ICDs) and is associated with diminished psychological functioning and quality of life. Multiple shocks and ICD storm are a relatively common event among patients with ICDs (10-20%) and may present specific challenging medical and psychological management for the attending health care providers. This paper examines the medical and psychological aspects of ICD shocks and storms and describes a model of biopsychosocial management for patients following the experience of ICD storm. Successful management of patients post shock includes the use of antiarrhythmic medications and careful attention to the causality of the shocks via stored electrograms. The psychological management includes specific attention to debriefing post-shock feelings and attributions, preventing avoidance behavior, and facilitating positive "return to life" actions. Preliminary research examining formal psychosocial treatment supports a cognitive behavioral strategy to reduce psychological distress and facilitate quality of life. Collectively, these data suggest that interdisciplinary management of patients with multiple ICD shocks or the experience of ICD storm is advised, and routine psychological consultation may be indicated for the patient post ICD storm to reduce the possibility of symptoms of post-traumatic stress.

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“…The results of large clinical trials show that the ES developed in ICD patients may be a strong predictor of arrhythmic and nonarrhythmic death, and also rehospitalization [7,8,11,23,24].…”

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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Electrical Storm Presages Nonsudden Death

Cited by 337 publications

References 40 publications

Long-Term Clinical Course of Patients After Termination of Ventricular Tachyarrhythmia by an Implanted Defibrillator

Long-Term Clinical Course of Patients After Termination of Ventricular Tachyarrhythmia by an Implanted Defibrillator

Understanding implantable cardioverter defibrillator shocks and storms: Medical and psychosocial considerations for research and clinical care

Intensive management of electrical storm and incessant ventricular arrhythmias

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