Clinical InvestigationElectrophysiologyElectrical storm in patients with biventricular implantable cardioverter defibrillator: Incidence, predictors, and prognostic implications
Section snippets
Methods
The InSync ICD Italian Registry is a prospective observational registry including patients with refractory HF, on optimized medical therapy, with LV dysfunction, and wide QRS complex, who received a CRT-D. For the purpose of this study, patients with HF in stable New York Heart Association (NYHA) class III to IV, with LV ejection fraction (LVEF) ≤35%, and QRS complex ≥120 milliseconds implanted with a Medtronic CRT-D device (Medtronic, Inc, Minneapolis, MN), were evaluated. Six hundred
Patient population
Six hundred thirty-one patients (90% male, mean age 66 ± 9 years) were enrolled in the study. Demographic and baseline clinical characteristics of the study population are shown in Table I. All patients had indication to biventricular pacing for CRT because of HF. Mean LVEF was 26% ± 7%, and mean QRS width was 164 ± 33 milliseconds. Two hundred sixty-four patients received a CRT-D device for secondary prevention of SCD1, 2, 3: Fifty-five of (20.8%) 264 patients were cardiac arrest survivors,
Discussions
This is the first study investigating the problem of ES in patients with HF implanted with CRT-D. Independent predictors of ES were found to be non–coronary artery disease (CAD) etiology and secondary prevention indication for an ICD. The role of baseline LVEF ≤25% in predicting ES, as reported for patients receiving single- or dual-chamber ICDs, was not confirmed by the present study for patients with HF treated with CRT-D. Compared with patients without ES, patients who experienced ES
Conclusions
In patients with HF treated with CRT-D, ES was not so frequent, being present in 7.1% of the overall population, with a rate of 4.5 patients per 100 patient-years. Electrical storm was higher in secondary prevention and in nonischemic patients. In patients with ES, NYHA functional class and LVEF improved marginally; moreover, patients with ES presented greater cardiovascular and, particularly, HF-related morbidity and mortality. These findings suggest that ES may be an indicator of gradually
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Cited by (28)
Predictors of cardiovascular mortality after an electrical storm in patients with structural heart disease
2022, Journal of CardiologyCitation Excerpt :Previous studies have shown that ESs are a crucial matter in patients with structural heart disease (SHD) who undergo ICD implantations [6,7]. However, the detailed mechanisms of a poor prognosis in ES patients remain unclear, whereas previous reports have suggested that an ES occurrence is followed by worsening heart failure (HF) and is associated with subsequent death [6,8]. Furthermore, little is known about the time period from the ES occurrence to cardiac mortality.
Characteristics and Outcomes in Patients With Electrical Storm
2019, American Journal of CardiologySignificant impact of electrical storm on mortality in patients with structural heart disease and an implantable cardiac defibrillator
2018, International Journal of CardiologyCitation Excerpt :Patients who receive ICD shocks for termination of any arrhythmias have been shown to be associated with a substantially higher risk of death than patients who do not receive such shocks [8,9]. The incidence, predictive factors, and clinical prognosis of patients with E-Storm were relatively well known in patients with ischemic heart disease (IHD) [10–13], but data are still lacking for other underlying heart diseases, especially in non-ischemic dilated cardiomyopathy (DCM). The Nippon Storm Study was a prospective observational study designed to recruit clinical data from patients on ICD therapy [14,15] to investigate the incidence and the clinical characteristics of patients who develop E-Storm in Japan where DCM is relatively common compared to other Western countries.
The role of catheter ablation in the management of patients with implantable cardioverter defibrillators presenting with electrical storm
2017, Hellenic Journal of CardiologyCitation Excerpt :ES events adversely impact survival in ICD patients irrespective of the causative arrhythmia.5 The same applies to Cardiac Resynchronization Therapy-Defibrillator (CRT-D) patients with ES who experience increased heart failure-related hospitalization and mortality rates relative to those with no ES.8 In most cases, there is no clear precipitant, and medical therapy alone may be inadequate to control the arrhythmia.
Effect of intravenous amiodarone on QT and T peak-T end dispersions in patients with nonischemic heart failure treated with cardiac resynchronization-defibrillator therapy and electrical storm
2015, Journal of ArrhythmiaCitation Excerpt :Most patients receive CRT with a defibrillator (CRT-D) because the indications for an implantable cardioverter-defibrillator (ICD) overlap with those for CRT. Electrical storm, which is commonly defined as the occurrence of 3 or more separate episodes of ventricular tachyarrhythmia requiring ICD therapies within 24 h [2], is associated with worse heart failure-related morbidity and survival among patients who receive CRT-D [3,4]. CRT may increase LV transmural dispersion of repolarization, leading to ventricular tachyarrhythmia and electrical storm induced by epicardial LV pacing [4–6].
See Appendix for the complete group of the InSync ICD Italian Registry Investigators.