Electrical storm in patients with transvenous implantable cardioverter-defibrillators - Incidence, management and prognostic implications
Electrical storm in patients with transvenous implantable cardioverter-defibrillators - Incidence, management and prognostic implications
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DOI：
10.1016/s0735-1097(98)00495-1
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发表时间：
1998-12-01
影响因子：
24
通讯作者：
Hohnloser, SH
中科院分区：
文献类型：
--
作者：
Credner, SC;Klingenheben, T;Hohnloser, SH
目标.本研究的目的是确定经静脉植入型心律转复除颤器（ICD）系统患者发生电风暴的确切发生率、治疗选择和预后意义。大约50%-70%接受ICD治疗的患者在前2年内接受了适当的基于器械的治疗。大多数心律失常事件仅需要一次适当的ICD击发即可终止。然而，一些患者在短时间内接受多次适当的电击，这种情况被称为“电风暴或电风暴”。“方法。这项前瞻性设计的观察性研究包括136名经静脉ICD接受者，随访403 +/- 242天。电风暴定义为在单个24小时内导致器械干预≥ 3次的室性心动过速或室颤。随访期间，57/136例患者（42%）接受了适当的ICD治疗。14/136例患者（10%）在ICD植入后平均133 ± 135天发生电风暴。每例患者构成电风暴的平均癫痫发作次数为17 +/- 17（范围：3 - 50;中位数8）。在12名患者中，电风暴需要住院治疗。通过β受体阻滞剂和静脉注射胺碘酮的联合治疗可以终止心律失常簇，而I类抗心律失常药物仅偶尔成功。Kaplan-Meier法估计的累积生存概率显示，与无电风暴事件的患者相比，有电风暴事件的患者预后并不差。电风暴是接受现代ICD治疗的患者的常见事件。最常发生在ICD植入后晚期，可通过β受体阻滞剂和胺碘酮联合治疗进行管理。电风暴并不独立地增加死亡率。（J Am科尔心脏病学1998;32：1909-15）（C）1998年美国心脏病学会。
Objectives. The purpose of this study was to determine the precise incidence, therapeutic options and prognostic implications of electrical storm in patients with transvenous implantable cardioverter-defibrillator (ICD) systems.Background. Approximately 50% to 70% of patients treated with an ICD receive appropriate device based therapy within the first 2 years. Most arrhythmic events require only one appropriate ICD firing for termination. However, some patients receive multiple appropriate shocks during a short period of time, a condition referred to as "arrhythmic or electrical storm."Methods. This prospectively designed observational study com prised 136 recipients of transvenous ICDs who were followed for 403 +/- 242 days. Electrical storm was defined as ventricular tachycardia or fibrillation resulting in device intervention greater than or equal to 3 times during a single 24-h period.Results. During follow up, 57/136 patients (42%) received appropriate ICD therapy. Electrical storm occurred in 14/136 patients (10%) at an average of 133 +/- 135 days after ICD implantation. The mean number of arrhythmic episodes constituting electrical storm was 17 +/- 17 (range: 3 to 50; median 8) per patient. In 12 patients, electrical storm required hospital admission. The arrhythmia cluster could be terminated by a combined therapy with beta-blockers and intravenous amiodarone whereas class I antiarrhythmic drugs were only occasionally successful. The cumulative probability of survival as estimated by the Kaplan-Meier method showed that patients with an episode of electrical storm did not have a worse outcome compared to those without such an event.Conclusions. Electrical storm represents a frequent event in patients treated with modern ICDs. It occurs most commonly late after ICD implantation and can be managed by combined therapy with beta-blockers and amiodarone. Electrical storm does not independently confer increased mortality. (J Am Coll Cardiol 1998;32:1909-15) (C) 1998 by the American College of Cardiology.