Document Detail

A less aggressive therapeutic option for electrical storm.
MedLine Citation:
PMID:  24217829     Owner:  NLM     Status:  In-Data-Review    
Electrical storm (ES) describes the rapidly clustering ventricular fibrillation (VF) that requires multiple cardioversions. Emerging evidence suggests that Purkinje arborization and sympathetic nerve regeneration play a major role in initiating malignant arrhythmias. We report the case of two patients who, after having survived an acute myocardial infarction (MI), developed repetitive episodes of polymorphic ventricular tachycardia and VF one week after percutaneous revascularization, triggered by monomorphic premature ventricular contractions (PVCs). Owing to repetitive and drug-refractory VF episodes, temporary atrial overdrive pacing was attempted with complete suppression of VF. In the following month, recurrence of ventricular arrhythmia was inversely related to the atrial pacing rate. Although antiarrhythmic drugs other than beta-blockers had been discontinued, neither PVCs nor ventricular arrhythmias recurred at one-month follow-up when the lower pacing rate was set at 60 bpm. In conclusion in these patients, ES was likely related to nerve sprouting after ischemic injury. This chaotic phenomenon occurs early after tissue damage and shows a peak seven days after acute MI with degeneration of superfluous axon branches. High pacing rates can reduce early after depolarizations and suppress PVCs, thus preventing ES. On these grounds, ES patients may be treated with temporary overdrive pacing rather than early radiofrequency ablation.
G Bertero; S Agosti; C Brunelli
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  La Clinica terapeutica     Volume:  164     ISSN:  1972-6007     ISO Abbreviation:  Clin Ter     Publication Date:    2013 Sep-Oct
Date Detail:
Created Date:  2013-11-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372604     Medline TA:  Clin Ter     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  421-4     Citation Subset:  IM    
Division of Cardiology, San Martino University Hospital, Genoa, Italy.
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