電気ストーム患者におけるアジュマリンの有効性と安全性

Antiarrhythmic drug (AAD) therapy is a cornerstone in managing electrical storm (ES). Data on the safety and efficacy of AADs besides beta-blockers and amiodarone are limited.

This retrospective observational study aimed at assessing the potential role of ajmaline in patients with ES refractory to guideline-recommended care.

Adult patients admitted to the ICU due to ES between 2013 and 2023 who received ajmaline for therapy-refractory ES were retrospectively analysed.

46 out of 332 patients with recurrent VT/VF (mean age 64±11 years, 93% male, mean LVEF 33±12%, 78% with implanted ICD) were treated with i.v. ajmaline. Most patients (98%) had known structural heart disease. Serious adverse events requiring discontinuation were not observed. Minor adverse events occurred in 3 patients (7%). Complete arrhythmia suppression was achieved in 34 patients (74%), partial suppression in 2 (4%), and VT slowing in 5 (11%). In 5 patients (11%), ajmaline showed no effect. During hospitalization, 5 patients (11%) died; 2 (4%) due to multi-organ failure and 3 (7%) of a combined septic and cardiogenic shock despite complete or partial arrhythmia suppression by ajmaline. 28 patients (61%) underwent catheter ablation, and 41 patients (89%) were discharged in stable rhythm. After a 6-month follow-up, 15 patients were lost to follow-up and 24 of the 26 remaining patients were still alive.

In selected patients with refractory ES, intravenous ajmaline treatment was associated with a reduction in VAs and a favourable safety profile. Ajmaline may serve as a valuable bridge to definitive treatment in life-threatening ES.