Elektrischer Sturm

Zarse, Markus; Hasan, Fuad; Khan, Atisha; Karosiene, Zana; Lemke, Bernd; Bogossian, Harilaos

doi:10.1007/s00399-020-00672-0

Cited by 3 publications

(2 citation statements)

References 38 publications

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“…The incidence of ES is estimated to be from 6% to 14% in patients with implantable cardioverter-defibrillators (ICDs) and has a high mortality rate [ 4 , 5 ]. The presentation varies from mild symptoms such as palpitations and chest discomfort to more severe outcomes such as syncope, cardiac arrest, and sudden death [ 6 ]. The underlying mechanisms are complex and multifactorial, with myocardial ischemia, sympathetic activation, electrolyte imbalances, and drug toxicity among the many contributing factors [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Life-Threatening Electrical Storm Following Liver Transplantation: A Case Report

Araujo Coelho,

Oliveira da Luz,

Teixeira Basto

et al. 2023

Am J Case Rep

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Patient: Female, 61-year-old Final Diagnosis: Electrical storm Symptoms: Cardiac arrest • ventricular fibrillation Clinical Procedure: — Specialty: Cardiology • Critical Care Medicine • Gastroenterology and Hepatology • Transplantology Objective: Unknown etiology Background: Electrical storm is a rare but potentially life-threatening syndrome characterized by recurrent ventricular arrhythmias. Liver transplant recipients are at increased risk of developing electrical storms due to conditions that prolong QT intervals, such as cirrhotic cardiomyopathy. However, limited information exists on electrical storms in this specific population. This case report presents a patient who experienced 13 cardiac arrests during ventricular fibrillation following liver transplantation. Case Report: A 61-year-old woman with a medical history of diabetes, obesity, and cirrhosis due to non-alcoholic fatty liver disease underwent liver transplantation using a deceased donor’s liver. Following the procedure, she developed a deterioration in her respiratory function, necessitating orotracheal intubation. Approximately 21 hours post-surgery, she experienced cardiac arrest during ventricular fibrillation, which was rapidly reversed with electrical defibrillation. However, the patient entered a state of electrical storm. Management involved antiar-rhythmic medications and temporary transvenous cardiac pacing. She remained stable for 40 hours, but a dislodgment of the device triggered another episode of ventricular fibrillation, leading to her death. Conclusions: This case report highlights the clinical presentation and challenges in managing electrical storms in liver transplant recipients. We hypothesize that cirrhotic cardiomyopathy could be the cause of her recurrent ventricular arrhythmias. Further studies are needed to better understand the underlying mechanisms and risk factors of this life-threatening syndrome in this population, which may enhance risk stratification and enable earlier intervention.

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Section: Introductionmentioning

confidence: 99%

Life-Threatening Electrical Storm Following Liver Transplantation: A Case Report

Araujo Coelho,

Oliveira da Luz,

Teixeira Basto

et al. 2023

Am J Case Rep

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“…The Electrical storm (ES) subsumes a state of electrical instability of the heart, which manifests itself in repeated and potentially fatal ventricular arrhythmias (VA) ranging from ventricular tachycardia (VT) to ventricular fibrillation (VF) ( 1 , 2 ). It affects the sickest of the sick heart failure patients and was up to the 1990s associated with an extremely poor prognosis of mortality rates between 80 and 90% ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Long-term prognosis of successful left ventricular substrate modification of electrical storm

Margkarian

Bogossian

Bandorski

et al. 2022

Front. Cardiovasc. Med.

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IntroductionThe Electrical storm (ES) subsumes a state of electrical instability of the heart, which manifests itself in repeated and potentially fatal ventricular arrhythmias (VA). We examine the long-term effects of substrate modification with regards to mortality, ventricular tachycardia (VT) recurrences and hospitalization depending on age, gender, heart function, scare location, VT documentation, postprocedural electrical stimulation (PES) and induced VTs.MethodsFrom 08/2008 and 09/2019 160 consecutive patients admitted for ES ablation via electroanatomical mapping were followed up until 04/2021.Results50/160 patients showed VT recurrences after 13.8 ± 21.7 (0.0–80.3) months, with a characteristic steep curve directly after ES and then a rapid decline leading to a plateau (first month 10/50 (20%), first year 35/50 VT recurrences (70%) Mortality rates followed a similar pattern also the initial decline was not as steep. 42 patients died during the observation period (26%) after 16.6 ± 16.1 (0.0-67.9) months after ablation day (first month (n = 7, 16.7%) first year (n = 21, 50%). Gender, age, scare localization, missing VT documentation did not worsen outcome. Induction of >3 VTs and lack of PES due to hemodynamic instability significantly decreased effectiveness. Finding the entry significantly increased long-term effects.ConclusionAblation of ES is safe and feasible independent of a variety of factors. Employing more sophisticated tools to understand the reentry mechanism will further improve the long-term outcome.

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A successful case of electrical storm rescue after acute myocardial infarction

Liu

Xie

Chen

et al. 2022

BMC Cardiovasc Disord

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Background Electrical storm (ES) is a heterogeneous clinical emergency that can present with malignant ventricular arrhythmias such as ventricular fibrillation (VF), ventricular tachycardia (VT), requiring the need for cardiac defibrillation. ES is a life-threatening condition with a high mortality rate. Successfully managing ES in the setting of acute myocardial infarction (MI) is expected to be known by physicians on call to reduce in-hospital mortality. Case presentation A 57-year-old man presenting with acute onset chest pain was found to have an infero-posterior ST-segment elevation myocardial infarction (STEMI) complicated by acute right ventricular MI secondary to total occlusion of the proximal right coronary artery (RCA). The patient developed ES in the form of recurrent VF that was managed successfully with electrical defibrillation, antiarrhythmic therapy with amiodarone and esmolol, endotracheal intubation, sedation, electrolyte replacement, volume resuscitation, comfort care, psychological intervention, and percutaneous coronary intervention (PCI) of the occluded epicardial artery. With these interventions used in quick succession and with the aspiration of a massive RCA thrombus, the patient was reversed to hemodynamic stability, did not have further episodes of VF, and survived the index hospitalization. Conclusion ES is a rare but fatal complication of acute MI. Residents on night shifts should be better prepared and equipped to deal with this rare condition. We hope our successful experience can benefit physicians on call who take care of acute MI patients that deteriorate with ES.

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Elektrischer Sturm

Cited by 3 publications

References 38 publications

Life-Threatening Electrical Storm Following Liver Transplantation: A Case Report

Life-Threatening Electrical Storm Following Liver Transplantation: A Case Report

Long-term prognosis of successful left ventricular substrate modification of electrical storm

A successful case of electrical storm rescue after acute myocardial infarction

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