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[Electrical storm: definition, prevalence, causes and prognostic implications].

Carsten W Israel1, Johannes C Manegold

  • 1Klinik für Innere Medizin - Kardiologie Diabetologie & Nephrologie, Evangelisches Krankenhaus Bielefeld, Burgsteig 13, 33617, Bielefeld, Deutschland, Carsten.Israel@evkb.de.

Herzschrittmachertherapie & Elektrophysiologie
|July 2, 2014
PubMed
Summary
This summary is machine-generated.

Electrical storm (ES), a dangerous heart rhythm instability, affects 25% of implantable cardioverter-defibrillator patients. Management focuses on reducing sympathetic tone and optimizing device programming to prevent further events.

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Area of Science:

  • Cardiology
  • Electrophysiology

Context:

  • Electrical storm (ES) is defined as ≥ 3 ventricular tachyarrhythmia (VT) detections within 24 hours in patients with an implantable cardioverter-defibrillator (ICD).
  • ES affects approximately 25% of ICD patients indicated for sudden cardiac death prophylaxis.
  • Triggers include heart failure, electrolyte imbalance, medication changes, illness, and stress.

Purpose:

  • To review the definition, triggers, and management of electrical storm in ICD patients.
  • To highlight the importance of optimizing ICD programming for ES prevention.

Summary:

  • ES management involves reducing sympathetic tone with beta-blockers and sedation.
  • Intravenous amiodarone is effective; Class I antiarrhythmic drugs are generally unsuccessful.
  • Substrate mapping and VT ablation can aid in treatment and prevention.
  • Optimized ICD programming to avoid shocks and favor antitachycardia pacing is crucial for prevention.

Impact:

  • ES has low immediate mortality but high hospitalization rates (50-80%).
  • Long-term prognostic implications require further investigation.
  • Effective management and prevention strategies are essential to improve patient outcomes.