Electrical storm in patients with implantable cardioverter-defibrillators: can it be forecast?
The aim of this retrospective study was to determine the prevalence and predictors of electrical storm in 227 patients who had received implantable cardioverter-defibrillators (ICDs) and had been monitored for 31.7 +/- 15.6 months. Of these, 174 (77%) were men. The mean age was 55.8 +/- 15.5 years (range, 20-85 yr), and the mean left ventricular ejection fraction (LVEF) was 0.30 +/- 0.14. One hundred forty-six of the patients (64%) had underlying coronary artery disease. Cardioverter-defibrillators were implanted for secondary (80%) and primary (20%) prevention. Of the 227 patients, 117 (52%) experienced events that required ICD therapy. Thirty patients (mean age, 57.26 +/- 14.3 yr) had > or = 3 episodes requiring ICD therapy in a 24-hour period and were considered to have electrical storm. The mean number of events was 12.75 +/- 15 per patient. Arrhythmia-clustering occurred an average of 6.1 +/- 6.7 months after ICD implantation. Clinical variables with the most significant association with electrical storm were low LVEF (P = 0.04; hazard ratio of 0.261, and 95% confidence interval of 0.08-0.86) and higher use of class IA antiarrhythmic drugs (P = 0.018, hazard ratio of 3.84, and 95% confidence interval of 1.47-10.05). Amiodarone treatment and use of beta-blockers were not significant predictors when subjected to multivariate analysis. We conclude that electrical storm is most likely to occur in patients with lower LVEF and that the use of Class IA antiarrhythmic drugs is a risk factor.
Emkanjoo
Zahra
Z
Department of Pacemaker & Electrophysiology, Rajaie Cardiovascular Medical & Research Center, Tehran 1996911151, Iran. emkanjoo@rhc.ac.ir
Alihasani
Narges
N
Alizadeh
Abolfath
A
Tayyebi
Mohammad
M
Bonakdar
Hamid
H
Barakpour
Hamid
H
Sadr-Ameli
Mohammad Ali
MA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012815:Signal Processing, Computer-Assisted; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left; D055815:Young Adult
D000889:Anti-Arrhythmia Agents