Electrical storm reveals worse prognosis compared to myocardial infarction complicated by ventricular tachyarrhythmias in ICD recipients

Abstract

Both acute myocardial infarction complicated by ventricular tachyarrhythmias (AMI–VTA) and electrical storm (ES) represent life-threatening clinical conditions. However, a direct comparison of both sub-groups regarding prognostic endpoints has never been investigated. All consecutive implantable cardioverter-defibrillator (ICD) recipients were included retrospectively from 2002 to 2016. Patients with ES apart from AMI (ES) were compared to patients with AMI accompanied by ventricular tachyarrhythmias (AMI–VTA). The primary endpoint was all-cause mortality at 3 years, secondary endpoints were in-hospital mortality, rehospitalization rates and major adverse cardiac event (MACE) at 3 years. A total of 198 consecutive ICD recipients were included (AMI–VTA: 56%; ST-segment elevation myocardial infarction (STEMI): 22%; non-ST-segment myocardial infarction (NSTEMI) 78%; ES: 44%). ES patients were older and had higher rates of severely reduced left ventricular ejection fraction (LVEF) < 35%. ES was associated with increased all-cause mortality at 3 years (37% vs. 19%; p = 0.001; hazard ratio [HR] = 2.242; 95% CI 2.291–3.894; p = 0.004) and with increased risk of first cardiac rehospitalization (44% vs. 12%; p = 0.001; HR = 4.694; 95% CI 2.498–8.823; p = 0.001). This worse prognosis of ES compared to AMI–VTA was still evident after multivariable adjustment (long-term all-cause mortality: HR = 2.504; 95% CI 1.093–5.739; p = 0.030; first cardiac rehospitalization: HR = 2.887; 95% CI 1.240–6.720; p = 0.014). In contrast, the rates of MACE (40% vs. 32%; p = 0.326) were comparable in both groups. At long-term follow-up of 3 years, ES was associated with higher rates of all-cause mortality and rehospitalization compared to patients with AMI–VTA.

Ventricular fibrillation/ventricular tachycardia within 72 h of VA‐ECMO: incidence, outcomes, risk factors, and management

“…The relevant literature shows that the overall survival rate of patients with VF/VT is only 8–15% 10 ; however, in the present study, the overall survival rate of these patients reached 48.6% after excluding those whose VA‐ECMO treatment time was <72 h, suggesting that VA‐ECMO may be effective for the treatment of refractory circulatory failure and salvage‐supportive treatment of VF/VT. Studies have shown that AMI is the most common cause of CA 6,20 and also the most common reversible cause of VF/VT; approximately 10% of patients with AMI may have VF/VT 21,22 . In the present study, patients with AMI had a higher probability of VF/VT occurring, accounting for ~48.57% of the patients evaluated, although there was no statistical difference compared with other cardiac aetiologies.…”

“…Studies have shown that AMI is the most common cause of CA 6,20 and also the most common reversible cause of VF/VT; approximately 10% of patients with AMI may have VF/VT. 21,22 In the present study, patients with AMI had a higher probability of VF/VT occurring, accounting for ~48.57% of the patients evaluated, although there was no statistical difference compared with other cardiac aetiol- ogies. Since the launch of VA-ECMO at our centre, coronary angiography, pulmonary artery computed tomography angiography, electrocardiography, metagenomics, and other in-depth examinations were routinely performed to identify the aetiology of the responsible diseases, while deterministic treatment has been actively performed for reversible aetiological factors.…”

Management of hemodynamically stable wide QRS complex tachycardia in patients with implantable cardioverter defibrillators

“…It is important to establish whether the current episode of sustained hemodynamically stable WCT is ES, since this situation entails elevated intra-hospital morbidity and mortality, especially in clinically compromised patients. ES is often an arrhythmic situation associated with compromised left ventricular systolic function, with heart failure symptoms, and other comorbidities ( 22 , 23 ). One study found that in CRT-D patients as well, ES was associated with non-ischemic heart disease, ICD secondary prevention indication, and with persistent heart failure symptoms and low LVEF despite CRT ( 24 ).…”

Post-Myocardial Revascularization: As a Nidus for an Electrical Storm!

“…ES carries an adverse prognosis; the majority of patients have a high mortality rate, with many succumbing within a short period, often minutes or hours, particularly if they have a recent history of myocardial infarction (MI) or persistent myocardial ischemia [ 3 ], and approximately 6% of cases involving acute coronary syndrome (ACS) are complicated by VA. The presence of irreversible myocardial ischemia leads to the development of focal and non-focal arrhythmogenic lesions that may progress into VF or VT [ 4 ]. Interestingly, as we will demonstrate in our case, arrhythmias that arise during the period of ischemia/reperfusion could be attributed to ischemia, no-reflow phenomenon following the opening of the infarct-related coronary artery, or reperfusion injury [ 5 ].…”