Predictors of cardiovascular mortality after an electrical storm in patients with structural heart disease
Takuya Koizumi1, Rui Kamada1, Masaya Watanabe1
1Department of Cardiovascular Medicine, Hokkaido University Hospital, Sapporo, Japan.
Insights
Electrical storms (ESs) in patients with structural heart disease (SHD) are linked to poor outcomes. End-stage heart failure is the primary cause of death, and implantable cardioverter defibrillator (ICD) shocks may increase cardiovascular death risk.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure
Background:
- Electrical storms (ESs) in patients with structural heart disease (SHD) are associated with poor prognosis.
- The precise causes of death and the impact of implantable cardioverter defibrillator (ICD) therapy in ES patients require further investigation.
Purpose of the Study:
- To explore the detailed clinical course following an ES in patients with SHDs.
- To evaluate the impact of ICD therapy on mortality in ES patients with SHDs.
Main Methods:
- Retrospective analysis of 31 consecutive patients with ESs who received ICD implantation.
- ESs defined as ≥3 ventricular arrhythmias within 24 hours.
- Mean follow-up of 4.5 years.
Main Results:
- 13 out of 31 patients died during follow-up (85% cardiovascular death).
- End-stage heart failure was the leading cause of cardiovascular death.
- New York Heart Association class ≥III and any ICD shock therapy were associated with increased cardiovascular death risk.
Conclusions:
- End-stage heart failure is the primary cause of death in ES patients with SHDs.
- ICD shock therapy is associated with cardiovascular death.
- Optimizing arrhythmia management to minimize ICD shocks may reduce mortality in ES patients.
Background:
Electrical storms (ESs) in patients with structural heart disease (SHD) have been reported to be associated with a poor prognosis. However, the detailed cause of death and influence of implantable cardioverter defibrillator (ICD) therapy in ES patients have not been fully investigated. Therefore, we sought to explore the detailed clinical course after an ES and the impact of the ICD therapy in patients with SHDs.
Methods:
We retrospectively analyzed 31 consecutive patients with ESs who had undergone an ICD implantation. ESs were defined as three or more ventricular arrhythmias within 24 h.
Results:
During a mean follow up of 4.5 years, 13 patients died. Among them, cardiovascular death (CVD) was observed in 11/13 (85%), and the leading cause of the CVD was end-stage heart failure. A New York Heart Association class ≥III at the time of the ES occurrence (HR 6.51 95% CI 1.94-25.1, p = 0.003) and any shock therapy (HR 5.94 95% CI 1.06-112.2, p = 0.04) were associated with CVD.
Conclusion:
In the current single center study, the major cause of death in ES patients with SHDs was end-stage heart failure. Any shock therapy was associated with CVD. Arrhythmia management to avoid ICD shocks might reduce the mortality in ES patients.
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