Ventricular tachycardia ablation and substrate modification in ICD patients with electrical storm

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.

Optimal antiarrhythmic drug therapy for electrical storm

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.

Valves replacement operation in treatment of electrical storm induced by rheumatic valves disease

Objective： To present a case of electrical storm （ES） in a female patient with rheumatic valve disease. Methods： A female patient with severe rheumatic valve disease suffered an unexpected ES. She received more than 50 electrical shocks for repeated cardiac arrests due to ES over 16 hours. Then she received beta-blocking agent treatment and had an operation of double valves replacement. Results： ES was suppressed by sympathetic blockade with beta-receptor blocker and finally disappeared after the double pathological valves had been replaced. Conclusion： Increased sympathetic activity plays an important role in the genesis of electrical storm and sympathetic blockade may effectively suppress ES. However, the most important thing in the treatment of ES is to identify and eliminate the underlying cause of ES.

Management of ventricular tachycardia storm in patients with structural heart disease

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.

Nicorandil as a promising therapeutic option for ventricular arrhythmia:A case report and review of literature

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.