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Electrical storm in patients with CHF: definition, clinical significance, treatment, and prevention

Osadchij A. M.1, Kurnikova E. A.2, Kamenev A. V.3, Lebedeva V. K.3, Vander M. A.3, Lubimtseva T. A.3, Shcherbak S. G.1, Lebedev D. S.3
1 – St.-Petersburg State Budgetary Institution of Health Care, “Municipal Hospital #40” of the Kurirtnyj Region”, Borisova 9, St.-Petersburg, Sestroretsk 197706
2 – State Budgetary Educational Institution of Higher Professional Education, “St.-Petersburg State Pediatric Medical University” of the RF Ministry of Heath Care, Litovskaya 2, St.-Petersburg 194100
3 – Federal State Budgetary Institution, “Almazov North-West Federal Medical Research Center” of the RF Ministry of Health Care, Akkuratova 2, St. Petersburg 97341

Keywords: IHD, heart rhythm disturbances, tachycardia, surgical methods

DOI: 10.18087/rhfj.2016.2.2189

Background. Progression of complicated IHD forms and the increasing use of implantable cardioverter defibrillators (ICDs) and triple-chambered pacemakers with a defibrillation function caused emergence of a new syndrome evident as frequently recurrent ventricular tachyarrhythmias, which can be stopped by defibrillation within a short time. This condition was named “electrical storm” (ES). Aim. To study epidemiology and clinical predictors for ES and ventricular tachyarrhythmias and their treatment in patients with triple-chambered cardioverter defibrillators (CRT-D), ICD and CHF. Materials and methods. This retrospective study included 461 patients managed in four multimodality clinics from 1999 through 2015. For prevention and treatment of sudden cardiac death (SCD) and CHF, ICDs and CRT-Ds were implanted to the patients. The patients were divided into two groups: Group 1 (n=39) consisted of patients with already developed ES and group 2 (n=422) consisted of patients without ES. Urgent catheter substrate ablation was performed for 11 patients of the ES group. Mean age of operated patients was 63.07±11.12 (84.3 % males). Results. ES developed in 8.2% of all patients. Among all patients, ICD (CRT-D) delivered 318 “shocks” per year. Patients with ES had LV EF <30%, electrolyte disorders, and increasing with time LV EDD significantly more frequently. Conclusion. Probability of ES was high within the first year following ICD implantation. Predictors of ES risk included reduced EF to below 30%, LV EDD >70 mm, progression of CHF by more than one FC; and electrolyte disorders (hypokalemia and hypomagnesemia). Urgent radiofrequency ablation (RFA) is an efficient and safe method of treatment.
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Osadchij A. M., Kurnikova E. A., Kamenev A. V., Lebedeva V. K., Vander M. A., Lubimtseva T. A. et al. Electrical storm in patients with CHF: definition, clinical significance, treatment, and prevention. Russian Heart Failure Journal. 2016;17 (2):106–113

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