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Electrical storm management in structural heart disease.

Veronica Dusi1,2, Filippo Angelini1, Carol Gravinese1

  • 1Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Corso Bramante 88, 10126 Turin, Italy.

European Heart Journal Supplements : Journal of the European Society of Cardiology
|May 1, 2023
PubMed
Summary

Electrical storm (ES), characterized by recurrent ventricular arrhythmias (VAs), significantly increases mortality in heart disease patients. Prompt recognition and multidisciplinary management, including ICD reprogramming and advanced therapies, are crucial for improving outcomes.

Keywords:
AblationElectrical stormNeuromodulationSedationVentricular arrhythmias

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Area of Science:

  • Cardiology
  • Electrophysiology

Background:

  • Electrical storm (ES) is a critical condition defined by recurrent ventricular arrhythmias (VAs) requiring intervention.
  • It poses a significant mortality risk (2-5 fold increase) for patients with structural heart disease, particularly those with implantable cardioverter defibrillators (ICDs) in secondary prevention.
  • Scar-related monomorphic VAs are a common presentation of ES.

Purpose of the Study:

  • To review the current understanding and management strategies for electrical storm.
  • To highlight the importance of early recognition and prompt, multidisciplinary treatment protocols.
  • To discuss advanced therapeutic options and recent European Society of Cardiology guidelines.

Main Methods:

  • Comprehensive review of literature on electrical storm management.
  • Analysis of acute and sub-acute/chronic phase treatment strategies.
  • Discussion of invasive and non-invasive advanced anti-arrhythmic interventions.

Main Results:

  • Electrical storm is a major adverse prognostic marker in structural heart disease.
  • Effective management necessitates a multidisciplinary approach with defined protocols.
  • Acute stabilization involves clinical assessment, resuscitation, sedation, ICD reprogramming, and sympathetic modulation.
  • Sub-acute/chronic management requires heart team evaluation for tailored treatment, including ablation or sympathetic denervation.

Conclusions:

  • Electrical storm management is complex and requires coordinated, multidisciplinary care.
  • Prompt intervention and tailored therapeutic strategies, including advanced ablation techniques, are vital for improving patient outcomes.
  • Adherence to updated guidelines is essential for optimal patient management.