Management of patients with electrical storm: an educational review.
Borislav DinovAngeliki DarmaSotirios NediosGerhard HindricksPublished in: European heart journal. Acute cardiovascular care (2022)
Electrical storm (ES) is a medical emergency that is defined as ≥ 3 separate ventricular tachycardia (VT) episodes causing ICD therapy within 24 h. Patients with ES have high risk for hospitalization, heart failure decompensation, in-hospital death. Furthermore, it is associated with significant anxiety and distress for the patients. Frequent triggers of ES are myocardial ischemia, acute decompensation of heart failure, metabolic and electrolyte disorders, drug side effects, increased sympathetic tone. Acute management of ES requires sedation, antiarrhythmic drugs and correction of the precipitating factors; although, in severe refractory cases, intubation, mechanical ventilation and circulatory support might be necessary. Radiofrequency catheter ablation is superior than antiarrhythmic drugs to suppress the ES and is also frequently required to terminate the ES as well as to achieve acute and long-term freedom of VT. Optimization of the ICD programming is crucial to reduce the burden of further appropriate and inappropriate shocks. Use of appropriate discrimination criteria and algorithms, ATPs and extending the detection times are important measures to reduce the burden of ES. In patients with end-stage heart failure, ES can be a sign of failing heart and can be refractory of treatment. In such cases, deactivation of the ICD therapy should be considered and discussed with patients and their care givers.
Keyphrases
- heart failure
- catheter ablation
- mechanical ventilation
- end stage renal disease
- atrial fibrillation
- respiratory failure
- healthcare
- liver failure
- drug induced
- chronic kidney disease
- ejection fraction
- newly diagnosed
- left ventricular
- machine learning
- public health
- prognostic factors
- palliative care
- acute respiratory distress syndrome
- intensive care unit
- stem cells
- risk factors
- left atrial
- aortic dissection
- extracorporeal membrane oxygenation
- depressive symptoms
- acute heart failure
- quality improvement
- deep learning
- ionic liquid
- sleep quality
- loop mediated isothermal amplification