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Electrical storm: A clinical and electrophysiological overview.

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  • 1Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy.

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|September 29, 2015
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Summary

Electrical storm (ES), a condition of recurrent ventricular arrhythmias requiring implantable cardioverter-defibrillator (ICD) therapy, presents significant management challenges. Catheter ablation offers a promising strategy to stabilize rhythm and improve survival in these critical cardiac patients.

Keywords:
Antiarrhythmic therapyCatheter ablationElectrical stormImplantable-cardioverter defibrillatorShockStructural heart diseaseVentricular tachycardia/fibrillation

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Area of Science:

  • Cardiology
  • Electrophysiology

Background:

  • Electrical storm (ES) is defined as ≥3 ventricular arrhythmia episodes requiring appropriate implantable cardioverter-defibrillator (ICD) therapies within 24 hours.
  • ES commonly involves monomorphic ventricular tachycardia but can also include polymorphic VT and ventricular fibrillation, often linked to underlying cardiomyopathies.
  • The condition leads to dramatic clinical presentations, electrical and hemodynamic decompensation, and high acute and long-term mortality.

Purpose of the Study:

  • To review the epidemiological and clinical aspects of electrical storm.
  • To evaluate acute and long-term follow-up implications of ES.
  • To focus on novel therapeutic strategies, particularly catheter ablation, for managing ES.

Main Methods:

  • Literature review of epidemiological and clinical data on electrical storm.
  • Analysis of treatment strategies, including pharmacological approaches, ICD programming, and catheter ablation.
  • Evaluation of the efficacy of catheter ablation in modifying arrhythmogenic substrate and improving outcomes.

Main Results:

  • ES management is challenging, with high mortality rates in both acute and long-term phases.
  • Underlying cardiomyopathies influence ES mechanisms and guide treatment decisions.
  • Catheter ablation has emerged as a pivotal treatment, demonstrating high efficacy in rhythm stabilization and reducing arrhythmia recurrence.

Conclusions:

  • Electrical storm necessitates comprehensive management strategies tailored to the underlying cardiac disease.
  • Catheter ablation is a highly effective intervention for ES, improving rhythm stability and overall survival.
  • Further research into novel therapeutic approaches is crucial for optimizing ES patient care and outcomes.