Document Detail


The evaluation and management of electrical storm.
MedLine Citation:
PMID:  21494516     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Electrical storm is an increasingly common and life-threatening syndrome that is defined by 3 or more sustained episodes of ventricular tachycardia, ventricular fibrillation, or appropriate shocks from an implantable cardioverter-defibrillator within 24 hours. The clinical presentation can be dramatic. Electrical storm can manifest itself during acute myocardial infarction and in patients who have structural heart disease, an implantable cardioverter-defibrillator, or an inherited arrhythmic syndrome. The presence or absence of structural heart disease and the electrocardiographic morphology of the presenting arrhythmia can provide important diagnostic clues into the mechanism of electrical storm. Electrical storm typically has a poor outcome.The effective management of electrical storm requires an understanding of arrhythmia mechanisms, therapeutic options, device programming, and indications for radiofrequency catheter ablation. Initial management involves determining and correcting the underlying ischemia, electrolyte imbalances, or other causative factors. Amiodarone and β-blockers, especially propranolol, effectively resolve arrhythmias in most patients. Nonpharmacologic treatment, including radiofrequency ablation, can control electrical storm in drug-refractory patients. Patients who have implantable cardioverter-defibrillators can present with multiple shocks and may require drug therapy and device reprogramming. After the acute phase of electrical storm, the treatment focus should shift toward maximizing heart-failure therapy, performing revascularization, and preventing subsequent ventricular arrhythmias. Herein, we present an organized approach for effectively evaluating and managing electrical storm.
Authors:
Michael Eifling; Mehdi Razavi; Ali Massumi
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital     Volume:  38     ISSN:  1526-6702     ISO Abbreviation:  Tex Heart Inst J     Publication Date:  2011  
Date Detail:
Created Date:  2011-04-15     Completed Date:  2011-08-09     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  8214622     Medline TA:  Tex Heart Inst J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  111-21     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
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MeSH Terms
Descriptor/Qualifier:
Anti-Arrhythmia Agents / therapeutic use*
Arrhythmias, Cardiac / diagnosis,  physiopathology,  therapy*
Catheter Ablation*
Defibrillators, Implantable
Electric Countershock* / instrumentation
Electrocardiography
Heart Conduction System / physiopathology*
Humans
Recurrence
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Arrhythmia Agents
Comments/Corrections

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