Electrical storm

Electrical storm

Electrical storm is a life threatening cardiac emergency characterized by recurrent ventricular tachycardia (VT)/fibrillation (VF). By definition three or more episodes separated by more than 5 minutes, within a period of 24 hours characterize an electrical storm [1]. Data on electrical storms are mainly available from those with implanted cardioverter defibrillators (ICD) as there is an accurate documentation of the event in the device memory. While an occurrence of 4% over twenty months has been noted in a primary prophylaxis situation [2], 20% over thirty months has been reported in those with an ICD implanted for secondary prophylaxis [3]. Similarly, one year survival in electrical storm is also highly variable, with reports ranging from 5 to 35% [4]. Mortality following an electrical storm is often due to progressive heart failure. It is not clear whether this is due to the occurrence of electrical storm in those who are very sick or the myocardial damage due to multiple shocks cause progressive heart failure [5].

References

1. European Heart Rhythm Association; Heart Rhythm Society, Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Moss AJ, Myerburg RJ, Priori SG, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC Jr, Jacobs AK, Adams CD, Antman EM, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B, Priori SG, Blanc JJ, Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL; American College of Cardiology; American Heart Association Task Force; European Society of Cardiology Committee for Practice Guidelines. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. J Am Coll Cardiol. 2006; 48: e247–346.
2. Sesselberg HW, Moss AJ, McNitt S, Zareba W, Daubert JP, Andrews ML, Hall WJ, McClinitic B, Huang DT; MADIT-II Research Group. Ventricular arrhythmia storms in postinfarction patients with implantable defibrillators for primary prevention indications: a MADIT-II substudy. Heart Rhythm. 2007; 4: 1395,
3. Exner DV, Pinski SL, Wyse DG, Renfroe EG, Follmann D, Gold M, Beckman KJ, Coromilas J, Lancaster S, Hallstrom AP; AVID Investigators. Antiarrhythmics Versus Implantable Defibrillators. Electrical storm presages non sudden death: the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial. Circulation. 2001;103:2066–2071.
4. Verma A, Kilicaslan F, Marrouche NF, Minor S, Khan M, Wazni O, Burkhardt JD, Belden WA, Cummings JE, Abdul-Karim A, Saliba W, Schweikert RA, Tchou PJ, Martin DO, Natale A. Prevalence, predictors, and mortality significance of the causative arrhythmia in patients with electrical storm. J Cardiovasc Electrophysiol. 2004;15:1265–1270.
5. Nademanee K, Taylor R, Bailey WE, Rieders DE, Kosar EM. Treating electrical storm: sympathetic blockade versus advanced cardiac life support-guided therapy. Circulation. 2000; 102: 742–747.