The electrical storm （ES） is defined as a state of electrical instability with three or more sustained ventricular arrhythmias （VAs） occurring within twenty-four hours, which needs intravenous antiarrhythmic medic...The electrical storm （ES） is defined as a state of electrical instability with three or more sustained ventricular arrhythmias （VAs） occurring within twenty-four hours, which needs intravenous antiarrhythmic medications and frequent defibrillation. Recently, radiofrequency catheter ablation evolved as a sole therapy to terminate ES in patients with ICD, and the survival has been reported to be improved with successful ablation during follow-up. In this review, we briefly summarize substrate mapping and substrate ablation strategy in patients with ES, and discuss the reason of recurrence after ablation.展开更多
Electrical storm(ES) is a medical emergency characterized by repetitive episodes of sustained ventriculararrhythmias(VAs) in a limited amount of time(at least 3 within a 24-h period) leading to repeated appropriate im...Electrical storm(ES) is a medical emergency characterized by repetitive episodes of sustained ventriculararrhythmias(VAs) in a limited amount of time(at least 3 within a 24-h period) leading to repeated appropriate implantable cardioverter defibrillator therapies. The occurrence of ES represents a major turning point in the natural history of patients with structural heart disease being associated with poor short-and longterm survival particularly in those with compromised left ventricular ejection fraction(LVEF) that can develop hemodynamic decompensation and multi-organ failure. Management of ES is challenging with limited available evidence coming from small retrospective series and a substantial lack of randomized-controlled trials. In general, a multidisciplinary approach including medical therapies such as anti-arrhythmic drugs, sedation, as well as interventional approaches like catheter ablation, may be required. Accurate patient risk stratification at admission for ES is pivotal and should take into account hemodynamic tolerability of VAs as well as comorbidities like low LVEF, advanced NYHA class and chronic pulmonary disease. In high risk patients, prophylactic mechanical circulatory support with left ventricular assistance devices or extracorporeal membrane oxygenation should be considered as bridge to ablation and recovery. In the present manuscript we review the available strategies for management of ES and the evidence supporting them.展开更多
Ventricular tachycardia storm （VTS） is defined as a life-threatening syndrome of three or more separate episodes of ventricular tachycardia （VT） leading to implantable cardioverter defibrillator （ICD） therapy wi...Ventricular tachycardia storm （VTS） is defined as a life-threatening syndrome of three or more separate episodes of ventricular tachycardia （VT） leading to implantable cardioverter defibrillator （ICD） therapy within 24 hours. Patients with VTS have poor outcomes and require immediate medical attention. ICD shocks have been shown to be associated with increased mortality in several studies. Optimal programming in minimization of ICD shocks may decrease mortality. Large controlled trials showed that long detection time and high heart rate detection threshold reduced ICD shock burden without an increase in syncope or death. As a fundamental therapy of ICD, anti- tachycardia pacing （ATP） can terminate most slow VT with a low risk of acceleration. For fast VT, burst pacing is more effective and less likely to result in acceleration than ramp pacing. One algorithm of optimal programming management during a VTS is presented in the review.展开更多
Recurrent Ventricular Tachycardia, or Electrical Storm, is a relatively common cause of mortality and morbidity after myocardial infarction. We present a case in which left stellate ganglion blocks were performed unde...Recurrent Ventricular Tachycardia, or Electrical Storm, is a relatively common cause of mortality and morbidity after myocardial infarction. We present a case in which left stellate ganglion blocks were performed under ultrasound guidance in order to alleviate recurrent ventricular tachycardia in a patient requiring extracorpeal membrane oxygenation after myocardial infarction. A medically complex 54-year-old male after two weeks removed from an acute ST elevation myocardial infarction status post stenting and intra-aortic balloon pump placement presented in the cardiovascular intensive care unit with recurrent unstable ventricular tachycardia while on extracorporeal membrane oxygenation and multiple vasoactive infusions. Our acute pain service was consulted by the cardiac electrophysiology service to provide left stellate ganglion blocks in attempt to attenuate electrical storm. Multiple single shot left stellate ganglion blocks were performed on subsequent days with increasing local anesthetic concentrations and volumes successfully providing temporary relief of electrical storm. A left stellate ganglion catheter was eventually placed, and a continuous infusion of local anesthesia was started. The patient experienced complete relief from unstable ventricular tachycardia and no further defibrillations were required. The catheter remained in place for 14 days allowing for extracorporeal membrane oxygenation decannulation without the return of electrical storm. We believe ultrasound guided left stellate ganglion blocks to be a relatively safe means to provide temporary relief of recurrent ventricular tachycardia.展开更多
BACKGROUND Ventricular arrhythmia is a common type of arrhythmia observed in clinical practice.It is primarily characterized by premature ventricular contractions,ventricular tachycardia,and ventricular fibrillation.A...BACKGROUND Ventricular arrhythmia is a common type of arrhythmia observed in clinical practice.It is primarily characterized by premature ventricular contractions,ventricular tachycardia,and ventricular fibrillation.Abnormal formation or transmission of cardiac electrical impulses in patients affects cardiac ejection function.It may present with symptoms such as palpitations,dyspnea,chest discomfort,and reduced exercise tolerance.In severe cases,ventricular arrhy-thmia can even lead to death.Therefore,prompt treatment is very much essential upon diagnosis.The symptoms did not improve after previous conventional drugs and electrical defibrillation treatment,but the ventricular arrhythmia was prevented after the addition of nicorandil.CASE SUMMARY A 75-year-old female patient was admitted to the hospital because of intermittent chest tightness,shortness of breath for 10 days,and fainting once for 7 days.Combined with laboratory tests and auxiliary examination,the patient was tentatively diagnosed with coronary heart disease or arrhythmia-atrial fibrillation.After admission,the patient had intermittent ventricular arrhythmia,which was uncontrolled with lidocaine,defibrillation,and amiodarone.However,when she was treated with nicorandil,the ventricular arrhythmia stopped.Nicorandil mitigates the action potential duration by facilitating the opening of potassium ion channels,thereby regulating the likelihood of premature and delayed depolar-ization in two distinct phases and subsequently averting the onset of malignant ventricular arrhythmia.Nicorandil may inhibit ventricular arrhythmia by dilating coronary arteries,improving coronary microcirculation and reducing myocardial fibrosis.CONCLUSION option for inhibiting ventricular arrhythmias.展开更多
Electrical storm, defined as 3 or more separate episodes of ventricular tachycardia or ventricular fibrillation within 24 hours, carries significant morbidity and mortality. These unstable ventricular arrhythmias have...Electrical storm, defined as 3 or more separate episodes of ventricular tachycardia or ventricular fibrillation within 24 hours, carries significant morbidity and mortality. These unstable ventricular arrhythmias have been described with a variety of conditions including ischemic heart disease, structural heart disease, and genetic conditions. While implantable cardioverter defibrillator implantation and ablation may be indicated and required, anti- arrhythmic medication remains an important adjunctive therapy for these persons.展开更多
Electrical storm(ES) is a clinical condition characterized by three or more ventricular arrhythmia episodes leading to appropriate implantable cardioverterdefibrillator(ICD) therapies in a 24 h period. Mostly, arrhyth...Electrical storm(ES) is a clinical condition characterized by three or more ventricular arrhythmia episodes leading to appropriate implantable cardioverterdefibrillator(ICD) therapies in a 24 h period. Mostly, arrhythmias responsible of ES are multiple morphologies of monomorphic ventricular tachycardia(VT), but polymorphic VT and ventricular fibrillation can also result in ES. Clinical presentation is very dramatic in most cases, strictly related to the cardiac disease that may worsen electrical and hemodynamic decompensation. Therefore ES management is challenging in the majority of cases and a high mortality is the rule both in the acute and in the long-term phases. Different underlying cardiomyopathies provide significant clues into the mechanism of ES, which can arise in the setting of structural arrhythmogenic cardiomyopathies or rarely in patients with inherited arrhythmic syndrome, impacting on pharmacological treatment, on ICD programming, and on the opportunity to apply strategies of catheter ablation. This latter has become a pivotal form of treatment due to its high efficacy in modifying the arrhythmogenic substrate and in achieving rhythm stability, aiming at reducing recurrences of ventricular arrhythmia and at improving overall survival. In this review, the most relevant epidemiological and clinical aspects of ES, with regard to the acute and long-term follow-up implications, were evaluated, focusing on these novel therapeutic strategies of treatment.展开更多
We report the case of a 63-year-old woman affected by a severe form of systemic scleroderma with pul-monary involvement(interstitial fibrosis diagnosed by biopsy and moderate pulmonary hypertension) and cardiac involv...We report the case of a 63-year-old woman affected by a severe form of systemic scleroderma with pul-monary involvement(interstitial fibrosis diagnosed by biopsy and moderate pulmonary hypertension) and cardiac involvement(paroxysmal atrial fibrillation, right atrial flutter treated by catheter ablation, ventricular tachyarrhythmias, previous dual chamber implantable cardioverter defibrillator implant). Because of recurrent electrical storms refractory to iv antiarrhythmic drugs the patient was referred to our institution to undergo catheter ablation. During electrophysiological proce-dure a 3D shell of cardiac anatomy was created with intracardiac echocardiography pointing out a significant right ventricular dilatation with a complex aneurysmal lesion characterized by thin walls and irregular multiple trabeculae. A substrate-guided strategy of catheter ab-lation was accomplished leading to a complete electri-cal isolation of the aneurism and to the abolishment of all abnormal electrical activities. The use of advanced strategies of imaging together with electroanatomical mapping added important information to the complex arrhythmogenic substrate and improved efficacy and safety.展开更多
文摘The electrical storm （ES） is defined as a state of electrical instability with three or more sustained ventricular arrhythmias （VAs） occurring within twenty-four hours, which needs intravenous antiarrhythmic medications and frequent defibrillation. Recently, radiofrequency catheter ablation evolved as a sole therapy to terminate ES in patients with ICD, and the survival has been reported to be improved with successful ablation during follow-up. In this review, we briefly summarize substrate mapping and substrate ablation strategy in patients with ES, and discuss the reason of recurrence after ablation.
文摘Electrical storm(ES) is a medical emergency characterized by repetitive episodes of sustained ventriculararrhythmias(VAs) in a limited amount of time(at least 3 within a 24-h period) leading to repeated appropriate implantable cardioverter defibrillator therapies. The occurrence of ES represents a major turning point in the natural history of patients with structural heart disease being associated with poor short-and longterm survival particularly in those with compromised left ventricular ejection fraction(LVEF) that can develop hemodynamic decompensation and multi-organ failure. Management of ES is challenging with limited available evidence coming from small retrospective series and a substantial lack of randomized-controlled trials. In general, a multidisciplinary approach including medical therapies such as anti-arrhythmic drugs, sedation, as well as interventional approaches like catheter ablation, may be required. Accurate patient risk stratification at admission for ES is pivotal and should take into account hemodynamic tolerability of VAs as well as comorbidities like low LVEF, advanced NYHA class and chronic pulmonary disease. In high risk patients, prophylactic mechanical circulatory support with left ventricular assistance devices or extracorporeal membrane oxygenation should be considered as bridge to ablation and recovery. In the present manuscript we review the available strategies for management of ES and the evidence supporting them.
文摘Ventricular tachycardia storm （VTS） is defined as a life-threatening syndrome of three or more separate episodes of ventricular tachycardia （VT） leading to implantable cardioverter defibrillator （ICD） therapy within 24 hours. Patients with VTS have poor outcomes and require immediate medical attention. ICD shocks have been shown to be associated with increased mortality in several studies. Optimal programming in minimization of ICD shocks may decrease mortality. Large controlled trials showed that long detection time and high heart rate detection threshold reduced ICD shock burden without an increase in syncope or death. As a fundamental therapy of ICD, anti- tachycardia pacing （ATP） can terminate most slow VT with a low risk of acceleration. For fast VT, burst pacing is more effective and less likely to result in acceleration than ramp pacing. One algorithm of optimal programming management during a VTS is presented in the review.
文摘Recurrent Ventricular Tachycardia, or Electrical Storm, is a relatively common cause of mortality and morbidity after myocardial infarction. We present a case in which left stellate ganglion blocks were performed under ultrasound guidance in order to alleviate recurrent ventricular tachycardia in a patient requiring extracorpeal membrane oxygenation after myocardial infarction. A medically complex 54-year-old male after two weeks removed from an acute ST elevation myocardial infarction status post stenting and intra-aortic balloon pump placement presented in the cardiovascular intensive care unit with recurrent unstable ventricular tachycardia while on extracorporeal membrane oxygenation and multiple vasoactive infusions. Our acute pain service was consulted by the cardiac electrophysiology service to provide left stellate ganglion blocks in attempt to attenuate electrical storm. Multiple single shot left stellate ganglion blocks were performed on subsequent days with increasing local anesthetic concentrations and volumes successfully providing temporary relief of electrical storm. A left stellate ganglion catheter was eventually placed, and a continuous infusion of local anesthesia was started. The patient experienced complete relief from unstable ventricular tachycardia and no further defibrillations were required. The catheter remained in place for 14 days allowing for extracorporeal membrane oxygenation decannulation without the return of electrical storm. We believe ultrasound guided left stellate ganglion blocks to be a relatively safe means to provide temporary relief of recurrent ventricular tachycardia.
文摘BACKGROUND Ventricular arrhythmia is a common type of arrhythmia observed in clinical practice.It is primarily characterized by premature ventricular contractions,ventricular tachycardia,and ventricular fibrillation.Abnormal formation or transmission of cardiac electrical impulses in patients affects cardiac ejection function.It may present with symptoms such as palpitations,dyspnea,chest discomfort,and reduced exercise tolerance.In severe cases,ventricular arrhy-thmia can even lead to death.Therefore,prompt treatment is very much essential upon diagnosis.The symptoms did not improve after previous conventional drugs and electrical defibrillation treatment,but the ventricular arrhythmia was prevented after the addition of nicorandil.CASE SUMMARY A 75-year-old female patient was admitted to the hospital because of intermittent chest tightness,shortness of breath for 10 days,and fainting once for 7 days.Combined with laboratory tests and auxiliary examination,the patient was tentatively diagnosed with coronary heart disease or arrhythmia-atrial fibrillation.After admission,the patient had intermittent ventricular arrhythmia,which was uncontrolled with lidocaine,defibrillation,and amiodarone.However,when she was treated with nicorandil,the ventricular arrhythmia stopped.Nicorandil mitigates the action potential duration by facilitating the opening of potassium ion channels,thereby regulating the likelihood of premature and delayed depolar-ization in two distinct phases and subsequently averting the onset of malignant ventricular arrhythmia.Nicorandil may inhibit ventricular arrhythmia by dilating coronary arteries,improving coronary microcirculation and reducing myocardial fibrosis.CONCLUSION option for inhibiting ventricular arrhythmias.
文摘Electrical storm, defined as 3 or more separate episodes of ventricular tachycardia or ventricular fibrillation within 24 hours, carries significant morbidity and mortality. These unstable ventricular arrhythmias have been described with a variety of conditions including ischemic heart disease, structural heart disease, and genetic conditions. While implantable cardioverter defibrillator implantation and ablation may be indicated and required, anti- arrhythmic medication remains an important adjunctive therapy for these persons.
文摘Electrical storm(ES) is a clinical condition characterized by three or more ventricular arrhythmia episodes leading to appropriate implantable cardioverterdefibrillator(ICD) therapies in a 24 h period. Mostly, arrhythmias responsible of ES are multiple morphologies of monomorphic ventricular tachycardia(VT), but polymorphic VT and ventricular fibrillation can also result in ES. Clinical presentation is very dramatic in most cases, strictly related to the cardiac disease that may worsen electrical and hemodynamic decompensation. Therefore ES management is challenging in the majority of cases and a high mortality is the rule both in the acute and in the long-term phases. Different underlying cardiomyopathies provide significant clues into the mechanism of ES, which can arise in the setting of structural arrhythmogenic cardiomyopathies or rarely in patients with inherited arrhythmic syndrome, impacting on pharmacological treatment, on ICD programming, and on the opportunity to apply strategies of catheter ablation. This latter has become a pivotal form of treatment due to its high efficacy in modifying the arrhythmogenic substrate and in achieving rhythm stability, aiming at reducing recurrences of ventricular arrhythmia and at improving overall survival. In this review, the most relevant epidemiological and clinical aspects of ES, with regard to the acute and long-term follow-up implications, were evaluated, focusing on these novel therapeutic strategies of treatment.
文摘We report the case of a 63-year-old woman affected by a severe form of systemic scleroderma with pul-monary involvement(interstitial fibrosis diagnosed by biopsy and moderate pulmonary hypertension) and cardiac involvement(paroxysmal atrial fibrillation, right atrial flutter treated by catheter ablation, ventricular tachyarrhythmias, previous dual chamber implantable cardioverter defibrillator implant). Because of recurrent electrical storms refractory to iv antiarrhythmic drugs the patient was referred to our institution to undergo catheter ablation. During electrophysiological proce-dure a 3D shell of cardiac anatomy was created with intracardiac echocardiography pointing out a significant right ventricular dilatation with a complex aneurysmal lesion characterized by thin walls and irregular multiple trabeculae. A substrate-guided strategy of catheter ab-lation was accomplished leading to a complete electri-cal isolation of the aneurism and to the abolishment of all abnormal electrical activities. The use of advanced strategies of imaging together with electroanatomical mapping added important information to the complex arrhythmogenic substrate and improved efficacy and safety.
