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Published on: February 28, 2012
Treatment of arrhythmic storm in implantable defibrillator patients
Lubomír Krivan1, Milan Kozák, Milan Sepsi
1Department of Medicine and Cardiology, University Hospital Bohunice, Brno, Czech Republic. lkrivan@fnbrno.cz
Insights
Arrhythmic storm (AS) significantly lowers survival rates in patients with implantable cardioverter-defibrillators (ICDs). This condition, primarily driven by ventricular tachycardia, necessitates urgent medical attention and increases hospital readmissions.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Arrhythmic storm (AS) is a recognized complication of implantable cardioverter-defibrillator (ICD) therapy.
- Understanding the prognostic implications of AS is crucial for patient management.
Purpose of the Study:
- To define the impact of arrhythmic storm on patient prognosis.
- To compare the overall mortality of patients experiencing AS with those who did not.
Main Methods:
- A cohort of 138 patients who received ICDs between 1994 and 2001 was analyzed.
- Patients with one or more AS episodes were statistically compared to those without malignant arrhythmias.
Main Results:
- Of 1490 analyzed arrhythmia episodes, 71% recurred, predominantly ventricular tachycardias (78%).
- AS occurred in 14% of patients, with higher incidence in those with LVEF <35% (18% vs. 8%).
- Total survival was significantly lower for patients with AS (36.8%) compared to those without (16.8%, p=0.042).
Conclusions:
- Arrhythmic storm serves as a critical risk marker for cardiac death.
- Ventricular tachycardia is the primary arrhythmia in AS episodes, more frequent than ventricular fibrillation.
- AS is associated with a 4.6-fold increase in hospital readmissions.
Background:
A common ICD therapy-related complication is arrhythmic storm (AS). The objective of our study was to define the impact of AS on patients' prognoses in order to compare the total mortality of AS patients with the rest of the group.
Material/Methods:
We studied 138 patients who received ICDs between 1994 and 2001. Patients who experienced one or more arrhythmic storms were statistically compared with patients who had no accumulation of malignant arrhythmia or no episodes.
Results:
One thousand four hundred ninety episodes of arrhythmia were analyzed. Arrhythmia recurrence was present in 71% of the patients. The majority of episodes (78%) were ventricular tachycardias and only 3% of episodes were ventricular fibrillation. Seventy percent of all arrhythmic episodes were asymptomatic. The ICD therapy sensitivity was 99.7%. Thirty-eight arrhythmic storms in 19 patients (14%) were observed during follow-up. The occurrence of AS was twice as high among patients with LVEF <35% than the rest of the group (18% vs. 8%). The total survival of patients with AS was significantly lower than that of the ICD patients who did not experience an AS (36.8% vs. 16.8%, p=0.042). All episodes of arrhythmic clusters during the AS were ventricular tachycardias.
Conclusions:
Arrhythmic storm is a serious risk marker for cardiac death. Ventricular tachycardia is a basic rhythm disorder of AS episodes and occurs significantly more often than ventricular fibrillation. Arrhythmic storm is responsible for a 4.6 times more frequent re-admission to hospital.
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