title: Electrical storm and heart failure worsening in implantable cardiac defibrillator patients.
abstract: OBJECTIVE
  In patients with an implantable cardiac defibrillator (ICD), electrical storm (ES) is associated with increased sudden and non-sudden cardiac mortality, the latter largely due to worsening heart failure (HF). Aim of this study is to test the association between ES and impending pump failure in patients with known chronic HF and ICD.
  
  
  RESULTS
  Inclusion criteria were a previous history of chronic HF, former ICD implant, and hospital admission for HF worsening, or ES, or unclustered ventricular tachyarrhythmias (VTs/VFs). Patients with concomitant stable HF or HF worsening due to another specific cause were excluded. Primary endpoint was all cause mortality. Main secondary endpoint was time to first rehospitalization. Prospective, observational study on 146 patients: 34 with ES, 30 with unclustered VTs/VFs, and 82 with HF worsening. During the 5 years of follow-up, there was no significant difference between survival estimates between ES and HF worsening (P = 0.7), while both were significantly lower than survival of unclustered VT/VF patients (all log rank P < 0.05). Hospitalization-free time was significantly lower in both the ES group and in the HF worsening group when compared with unclustered VT/VF patients (all log rank P < 0.05). There was no significant difference between hospitalization estimates between ES and HF worsening.
  
  
  CONCLUSIONS
  Heart failure patients admitted for ES have major similarities with patients admitted for HF clinical decompensation such as similar survival, cause of death and time to first rehospitalization. There is evidence suggesting that, in this population, ES could be considered as a clinical manifestation of HF worsening.
authors.affiliation: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca, 71, 60126 Ancona, Italy f.guerra@univpm.it.
authors.forename: Federico
authors.initials: F
authors.lastname: Guerra
authors.affiliation: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca, 71, 60126 Ancona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Flori
authors.affiliation: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca, 71, 60126 Ancona, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bonelli
authors.affiliation: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca, 71, 60126 Ancona, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Patani
authors.affiliation: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca, 71, 60126 Ancona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Capucci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000401:mortality* / Q000628:therapy; D014693:Ventricular Fibrillation / Q000401:mortality* / Q000628:therapy
keywords: Acute heart failure; Electrical storm; Implantable cardioverter-defibrillator; Ventricular fibrillation; Ventricular tachyarrhythmia; Worsening heart failure