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[Electrical storm : Recognition and management].

Markus Zarse1,2, Fuad Hasan3, Atisha Khan3

  • 1Klinikum Lüdenscheid, Klinik für Kardiologie, Elektrophysiologie und Angiologie, Märkische Kliniken GmbH, Paulmannshöherstraße 10-14, 58515, Lüdenscheid, Deutschland. Markus.Zarse@klinikum-luedenscheid.de.

Herzschrittmachertherapie & Elektrophysiologie
|February 16, 2020
PubMed
Summary
This summary is machine-generated.

Electrical storm (ES), characterized by frequent ventricular tachycardia, requires prompt, multidisciplinary care. Early sedation, beta-blockade, and optimized device management are crucial for breaking the cycle and improving patient outcomes.

Keywords:
AblationCardiac sympathetic denervationCirculatory support systemsImplantable cardioverter–defibrillator therapyTachycardia

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Critical Care Medicine

Background:

  • Electrical storm (ES) is a life-threatening condition defined as ≥3 ventricular tachycardia episodes within 24 hours.
  • Patients often present with severe heart failure and comorbidities, necessitating specialized care.
  • Ongoing tachycardia and cardioversions can traumatize patients, highlighting the need for immediate, effective interventions.

Purpose of the Study:

  • To outline a comprehensive management strategy for electrical storm.
  • To emphasize the importance of early, aggressive treatment to break the cycle of sympatho-adrenergic hyperactivation.
  • To discuss the role of device management and advanced therapies in refractory cases.

Main Methods:

  • Initial management includes deep sedation and beta-blockade to control autonomic hyperactivation.
  • Evaluation for and treatment of supraventricular tachycardias (SVT) and optimization of implantable cardioverter-defibrillator (ICD) programming.
  • Cardioversion, pharmacological suppression, ablation, and in refractory cases, cardiac sympathetic denervation or revascularization.

Main Results:

  • Early deep sedation and beta-blockade are highly effective in breaking the ES cycle.
  • Addressing SVT and optimizing ICD programming resolve ES in many cases.
  • Refractory ES may require advanced interventions like emergency ablation, revascularization, or sympathetic denervation.

Conclusions:

  • Electrical storm management requires a multidisciplinary approach, prioritizing early intervention.
  • Preventing unnecessary ICD discharges is critical as they worsen prognosis.
  • Close patient monitoring, potentially with telemedicine, is essential due to the poor prognosis following ES.