Treating electrical storm : sympathetic blockade versus advanced cardiac life support-guided therapy.
BACKGROUND
Electrical storm (ES), defined as recurrent multiple ventricular fibrillation (VF) episodes, often occurs in patients with recent myocardial infarction. Because treating ES according to the Advanced Cardiac Life Support (ACLS) guidelines yields a poor outcome, we evaluated the efficacy of sympathetic blockade in treating ES patients and compared their outcome with that of patients treated according to the ACLS guidelines.


RESULTS
Forty-nine patients (36 men, 13 women, mean age 57+/-10 years) who had ES associated with a recent myocardial infarction were separated into 2 groups. Patients in group 1 (n=27) received sympathetic blockade treatment: 6 left stellate ganglionic blockade, 7 esmolol, and 14 propranolol. Patients in group 2 (n=22) received antiarrhythmic medication as recommended by the ACLS guidelines. Patient characteristics were similar in the 2 groups. The 1-week mortality rate was higher in group 2: 18 (82%) of the 22 patients died, all of refractory VF; 6 (22%) of the 27 group 1 patients died, 3 of refractory VF (P<0.0001). Patients who survived the initial ES event did well over the 1-year follow-up period: Overall survival in group 1 was 67%, compared with 5% in group 2 (P<0.0001).


CONCLUSIONS
Sympathetic blockade is superior to the antiarrhythmic therapy recommended by the ACLS guidelines in treating ES patients. Our study emphasizes the role of increased sympathetic activity in the genesis of ES. Sympathetic blockade-not class 1 antiarrhythmic drugs-should be the treatment of choice for ES.
Nademanee
K
K
Electrophysiology and Pacing Center, Division of Cardiology, School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. nademane@hsc.usc.edu
Taylor
R
R
Bailey
W E
WE
Rieders
D E
DE
Kosar
E M
EM
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001340:Autonomic Nerve Block; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000627:therapeutic use; D011433:Propranolol / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence; D013233:Stellate Ganglion / Q000503:physiopathology; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000188:drug therapy / Q000628:therapy*
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D011412:Propanolamines; D011433:Propranolol; C036604:esmolol