Yonsei Med J.  2011 Jan;52(1):26-32. 10.3349/ymj.2011.52.1.26.

Electrical Storms in Patients with an Implantable Cardioverter Defibrillator

• Song PS
• Kim JS
• Shin DH
• Park JW
• Bae KI
• Lee CH
• Jung DC
• Ryu DR
• On YK

• KMID: 1106433
• DOI: http://doi.org/10.3349/ymj.2011.52.1.26

Abstract

PURPOSE
In some patients with an implantable cardioverter defibrillator (ICD), multiple episodes of electrical storm (ES) can occur. We assessed the prevalence, features, and predictors of ES in patients with ICD.
MATERIALS AND METHODS
Eighty-five patients with an ICD were analyzed. ES was defined as the occurrence of two or more ventricular tachyarrhythmias within 24 hours.
RESULTS
Twenty-six patients experienced at least one ES episode, and 16 patients experienced two or more ES episodes. The first ES occurred 209 +/- 277 days after ICD implantation. In most ES cases, the index arrhythmia was ventricular tachycardia (65%). There were no obvious etiologic factors at the onset of most ES episodes (57%). More patients with a structurally normal heart (p = 0.043) or ventricular fibrillation (VF) as the index arrhythmia (p = 0.017) were in the ES-free group. Kaplan-Meier estimates and a log-rank test showed that patients with nonischemic dilated cardiomyopathy (DCMP) (log-rank test, p = 0.016) or with left ventricular ejection fraction < 35% (p = 0.032) were more likely to experience ES, and that patients with VF (p = 0.047) were less affected by ES. Cox proportional hazard regression analysis showed that nonischemic DCMP correlated with a greater probability of ES (hazard ratio, 3.71; 95% confidence interval, 1.16-11.85; p = 0.027).
CONCLUSION
ES is a common and recurrent event in patients with an ICD. Nonischemic DCMP is an independent predictor of ES. Patients with VF or with a structurally normal heart are less likely to experience ES.

Keyword

Implantable cardioverter defibrillators; ventricular tachycardia; ventricular fibrillation

MeSH Terms

Adult
Aged
Defibrillators, Implantable/*adverse effects
Female
Humans
Male
Middle Aged
Tachycardia, Ventricular/*diagnosis/etiology
Ventricular Fibrillation/*diagnosis/etiology

Figure

• 

  Fig. 1 Presumed etiologic factors of electrical storm. Cause assignment was made by the physician at the time the electrical storm occurred. CHF, congestive heart failure.

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