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Ventricular tachyarrhythmia and “electrical storm” in patients with ACS

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

Keywords: ventricular tachyarrhythmias, heart rhythm disturbances, ACS

DOI: 10.18087/rhj.2016.3.2190

Background. Ventricular arrhythmias (VAs) associated with ACS, which manifest themselves as polymorphous ventricular tachycardia (VT) or ventricular fibrillation (VF), occur in 2 to 7 % of patients with acute myocardial ischemia and generally with a genetic predisposition. A severe and serious problem of patients with ACS is development of a life-threatening condition, “electrical storm” (ES). Aim. To study incidence and RFs of ventricular tachyarrhythmia and ES and to evaluate the effectiveness of therapy for ES in patients with ACS. Materials and methods. This retrospective study included 897 patients who were managed in St.‑Petersburg hospitals in 2015. During that period, 212 patients received therapy for ACS. Among all patients, 15 patients had recurrent, persistent VT and cases of ES. Based on VAs and ES, patients were divided into two groups: group 1 (n=15) included patients with ES and group 2 (n=197) – patients without ES. Mean age of patients was 65.2±9.1 (males, 62.4 %). Results. 7 % of patients developed ES. Development of ES significantly correlated with the following indexes: LV EF, rs= –0.5632, р<0.05; grade 2 or higher mitral insufficiency (MI), rs=+0.4204, р<0.05; and electrolyte imbalance, rs=+0.7104; р<0.005. In patients with ACS, the ES incidence was significantly higher in Killip class 2 and 3 acute HF. Multiple ventricular arrhythmias and ES developed more frequently when the main left coronary (LCA) (85–90 %), proximal portion of the right coronary artery (RCA) or the anterior interventricular branch of LCA were affected. Conclusion. Treatment of ES and recurrent ventricular tachyarrhythmias in patients with ACS requires emergency admission to a cardiac intensive care unit for diagnosis and treatment according to a strict algorithm with elimination of all causes for heart rhythm disorders.
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Osadchij A. M., Kamenev A. V., Agarkov M. V., Kurnikova E. A.,Dydymov R. Kh., Khilchuk A. A. et al. Ventricular tachyarrhythmia and “electrical storm” in patients with ACS. Russian Heart Journal. 2016;15 (3):175–180

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