Recent insights into mechanisms and clinical approaches to electrical storm

Abstract Background The short-coupled variant of torsade de pointes (sc-TdP) is a malignant arrhythmia that frequently presents with ventricular fibrillation (VF) electrical storm. Verapamil is considered the first-line therapy of sc-TdP while catheter ablation is not widely adopted. The aim of this study was to determine the origin of sc-TdP and to assess the outcome of catheter ablation using 3D-mapping. Methods and results We retrospectively analyzed five patients with sc-TdP who underwent 3D-mapping and ablation of sc-TdP at five different institutions. Four patients initially presented with sudden cardiac arrest, one patient experienced recurrent syncope as the first manifestation. All patients demonstrated a monomorphic premature ventricular contraction (PVC) with late transition left bundle branch block pattern, superior axis, and a coupling interval of less than 300 ms. triggering recurrent TdP and VF. In four patients, the culprit PVC was mapped to the free wall insertion of the moderator band (MB) with a preceding Purkinje potential in two patients. Catheter ablation using 3D-mapping and intracardiac echocardiography eliminated sc-TdP in all patients, with no recurrence at mean 2.7 years (range 6 months to 8 years) of follow-up. Conclusion 3D-mapping and intracardiac echocardiography demonstrate that sc-TdP predominantly originates from the MB free wall insertion and its Purkinje network. Catheter ablation of the culprit PVC at the MB free wall junction leads to excellent short- and long-term results and should be considered as first-line therapy in recurrent sc-TdP or electrical storm. Graphic abstract

Download Full-text

Electrical Storm Ablation in a Patient in Cardiogenic Shock Supported by Impella 5.0

JACC: Case Reports ◽

10.1016/j.jaccas.2020.12.032 ◽

2021 ◽

Vol 3 (3) ◽

pp. 486-490

Author(s):

Robin Le Ruz ◽

Gilles Lande ◽

Thierry Lepoivre ◽

Charles-Henri David ◽

Magali Michel ◽

...

Keyword(s):

Cardiogenic Shock ◽

Electrical Storm

Download Full-text

Stellate ganglion blockade with percutaneous bupivacaine injection followed with surgical denervation in the management of electrical storm

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2021.05.010 ◽

2021 ◽

Author(s):

Ş. Külahçıoğlu ◽

B. Kültürsay ◽

A. Küp ◽

M.E. Gürcü ◽

M.E. Çardak ◽

...

Keyword(s):

Stellate Ganglion ◽

Electrical Storm ◽

Stellate Ganglion Blockade

Download Full-text

Electrical storm reveals worse prognosis compared to myocardial infarction complicated by ventricular tachyarrhythmias in ICD recipients

Heart and Vessels ◽

10.1007/s00380-021-01844-9 ◽

2021 ◽

Author(s):

Julian Müller ◽

Michael Behnes ◽

Tobias Schupp ◽

Dominik Ellguth ◽

Gabriel Taton ◽

...

Keyword(s):

Myocardial Infarction ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Electrical Storm ◽

Ventricular Tachyarrhythmias ◽

Ventricular Ejection Fraction ◽

St Segment ◽

All Cause Mortality ◽

Worse Prognosis

AbstractBoth acute myocardial infarction complicated by ventricular tachyarrhythmias (AMI–VTA) and electrical storm (ES) represent life-threatening clinical conditions. However, a direct comparison of both sub-groups regarding prognostic endpoints has never been investigated. All consecutive implantable cardioverter-defibrillator (ICD) recipients were included retrospectively from 2002 to 2016. Patients with ES apart from AMI (ES) were compared to patients with AMI accompanied by ventricular tachyarrhythmias (AMI–VTA). The primary endpoint was all-cause mortality at 3 years, secondary endpoints were in-hospital mortality, rehospitalization rates and major adverse cardiac event (MACE) at 3 years. A total of 198 consecutive ICD recipients were included (AMI–VTA: 56%; ST-segment elevation myocardial infarction (STEMI): 22%; non-ST-segment myocardial infarction (NSTEMI) 78%; ES: 44%). ES patients were older and had higher rates of severely reduced left ventricular ejection fraction (LVEF) < 35%. ES was associated with increased all-cause mortality at 3 years (37% vs. 19%; p = 0.001; hazard ratio [HR] = 2.242; 95% CI 2.291–3.894; p = 0.004) and with increased risk of first cardiac rehospitalization (44% vs. 12%; p = 0.001; HR = 4.694; 95% CI 2.498–8.823; p = 0.001). This worse prognosis of ES compared to AMI–VTA was still evident after multivariable adjustment (long-term all-cause mortality: HR = 2.504; 95% CI 1.093–5.739; p = 0.030; first cardiac rehospitalization: HR = 2.887; 95% CI 1.240–6.720; p = 0.014). In contrast, the rates of MACE (40% vs. 32%; p = 0.326) were comparable in both groups. At long-term follow-up of 3 years, ES was associated with higher rates of all-cause mortality and rehospitalization compared to patients with AMI–VTA.

Download Full-text