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A less aggressive therapeutic option for electrical storm
G Bertero1, S Agosti, C Brunelli
1Division of Cardiology, San Martino University Hospital, Genoa, Italy.
La Clinica Terapeutica
|November 13, 2013
Summary
Electrical storm (ES), a dangerous heart rhythm, may stem from nerve regrowth after heart attack. Temporary pacing effectively controlled ES in two patients, suggesting a new treatment approach.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Surgery
Background:
- Electrical storm (ES) is characterized by frequent ventricular fibrillation (VF) episodes requiring cardioversion.
- Emerging research implicates Purkinje fiber network and sympathetic nerve regeneration in initiating malignant arrhythmias.
- Acute myocardial infarction (MI) survivors are at risk for developing life-threatening ventricular arrhythmias.
Observation:
- Two patients developed recurrent polymorphic ventricular tachycardia and VF post-MI and revascularization, triggered by premature ventricular contractions (PVCs).
- Episodes were drug-refractory, necessitating intervention.
- Temporary atrial overdrive pacing completely suppressed VF in both patients.
Findings:
- Ventricular arrhythmia recurrence showed an inverse relationship with atrial pacing rate.
- At a lower pacing rate of 60 bpm, neither PVCs nor VF recurred at one-month follow-up.
- ES in these patients was likely linked to post-ischemic nerve sprouting and degeneration.
Implications:
- High atrial pacing rates may suppress early afterdepolarizations and PVCs, thereby preventing ES.
- Temporary overdrive pacing could be a viable alternative to radiofrequency ablation for managing early-phase ES post-MI.
- This suggests a novel therapeutic strategy targeting nerve regeneration in managing electrical storm.
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