© 2000 by European Society of Cardiology
Is electrical storm in ICD patients the sign of a dying heart?
Outcome of patients with clusters of ventricular tachyarrhythmias
Division of Cardiology, St Michael's Hospital Toronto and The Department of Medicine, University of Toronto Toronto, Canada
BACKGROUND: Electrical storm in patients with implanted cardioverter defibrillators (ICDs) is purported to carry an ominous prognosis.
METHODS AND RESULTS: We retrospectively compared 40 patients with electrical storm (defined as three or more episodes of ventricular arrhythmia requiring ICD therapy in a 24 h period) with those only having isolated appropriate ICD therapy (n=57) and with patients having no or only inappropriate ICD therapy (n=125). All patients received ICDs for documented sustained VT or VF. There was no significant difference in age, sex, ejection fraction, total follow-up time, or underlying heart disease between any of the three groups. Patients who had electrical storm received their first appropriate ICD therapy 275±369 days post-implant (35% had storm as their first event) with storm occurring an average of 599±710 days post-implant. Patients had 1·5±1·0 storms in total (median=1), with 55±91 episodes per storm. There were no significant differences in actuarial survival at 5-year follow-up between the three groups. Eighty percent of storm patients were alive 5 years post-implant.
CONCLUSION: Storm is a common occurrence in ICD patients, can occur at any time during the follow-up period, and does not independently confer increased mortality.
Key Words: Implantable cardioverter defibrillators, survival, antiarrhythmia agents, electrical storm
Correspondence: Paul Dorian, St Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8.
[1] Kowey PR, Marinchak RA, Rials SJ, Rubin AM, Smith L. Electrophysiologic testing in patients who respond acutely to intravenous amiodarone for incessant ventricular tachyarrhythmias. Am Heart J 1993; 125: 1628–1632.[CrossRef][Web of Science][Medline]
[2] Villacastin J, Almendral J, Arenal A, Albertos J, Ormaetxre J, Peinado R, Bueno H, Merino JL, Pastor A, Medina O, Tercedor L, Jimenez F, Delcan JL. Incidence and clinical significance of multiple consecutive, appropriate, high-energy discharges in patients with implanted cardioverter-defibrillators. Circulation 1996; 93: 753–762.
[3] Credner SC, Klingenheben T, Mauss O, Sticherling C, Hohnloser SH. Electrical storm in patients with transvenous implantable cardioverter-defibrillators. Incidence, management and prognostic implications. J Am Coll Cardiol 1998; 32: 1909–1915.
[4] Kowey PR, Levine JH, Herre JM, Pacifico A, Lindsay BD, Plumb VJ, Janosik DL, Kopelman HA, Scheinman MM. Randomized, double-blind comparison of intravenous amiodarone and bretylium in the treatment of patients with recurrent, hemodynamically destabilizing ventricular tachycardia or fibrillation. Circulation 1995; 92: 3255–3263.
[5] Scheinman MM, Levine JH, Cannom DS, Friehling T, Kopelman HA, Chilson DA, Platia EV, Wilber DJ, Kowey PR. Dose ranging study in intravenous amiodarone in patients with life-threatening ventricular tachyarrhythmias. Circulation 1995; 92: 3264–3272.
[6] Levine JH, Massumi A, Scheinman MM, Winkle RA, Platia EV, Chilson DA, Gomes JA, Woosley RL. Intravenous amiodarone for recurrent sustained hypotensive ventricular tachycardia. J Am Coll Cardiol 1996; 27: 67–75.[Abstract]
[7] Jung W, Manz M, Pfeiffer D, Tebbenjohanns J, Pizzulli L, Luderitz B. Effects of antiarrhythmic drugs on epicardial defibrillation energy requirements and the rate of defibrillator discharges. Pacing Clinical Electrophysiol 1993; 16: 198–201.[CrossRef][Medline]
[8] Jung W, Manz M, Pizzulli L, Pfeiffer D, Lüderitz B. Effects of chronic amiodarone therapy on defibrillation threshold. Am J Cardiol 1992; 70: 1023–1027.[CrossRef][Web of Science][Medline]
[9] Daoud EG, Ching Man K, Horwood L, Morady F, Strickberger SA. Relation between Amiodarone and desethylamiodarone plasma concentrations and ventricular defibrillation energy requirements. Am J Cardiol 1997; 79: 97–100.[CrossRef][Web of Science][Medline]
[10] Gottleib CD and Horwitz LN. Potential interactions between the antiarrhythmic medication and the automatic implantable cardioverter defibrillator. Pacing Clinical Electrophysiol 1991; 14: 898–904.[CrossRef][Medline]
[11] The AVID Investigators. A comparison of antiarrhythmicdrug therapy with implantable defibrillators in patients resuscitated from near fatal ventricular arrhythmias. N Engl J Med 1997; 337: 1576–1583.
[12] Khono T, Bhandari AK, Park Y, Hollman A, Lerman RD, Cannom DS. Cluster shocks in patients with third generation implantable cardioverter defibrillators: Frequency, mechanisms and clinical significance. Pacing Clinical Electrophysiol 1995; 18: 846.
[13] Kluger J, Veronneau J, Fisher J. Cluster shocks: a strong predicter of subsequent mortality in patients with internal cardioverter defibrillators (Abstr). Pacing Clinical Electrophysiol 1995; 18: 845.[CrossRef]
[14] Nunain SO, Roelke M, Trouton T, Osswald S, Kim YH, Sosa-Suarez G, Brooks DR, McGovern B, Guy M, Torchiana DF, Vlahakas GJ, Garan H, Ruskin JN. Limitations and late complications of third generation automatic cardioverter-defibrillators. Circulation 1995; 91: 2204–2213.
[15] Greenberg YJ, MacPherson CA, Lewis RJ, Batsford WP, Rosenfeld LE. Etiology, therapy and prognosis of incessant defibrillator discharges (Abstr). Circulation 1995; 92: I-605.
[16] Bardy GH, Yee R, Jung W. Multicenter experience with a pectoral unipolar implantable cardioverter-defibrillator. J Am Coll Cardiol 1996; 28: 400–410.[Abstract]
[17] Myerburg RJ, Luceri RM, Thurer R, Cooper DK, Zaman L, Interian A, Fernandez P, Cox M, Glicksman F, Castellanos A. Article title. J Am Coll Cardiol 1989; 14: 508–514.[Abstract]
[18] Tebbenjohanns J, Schumacher B, Jung W, Korte T, Pfeiffer D, Manz M, Lüderitz B. Predictors of outcome in patients with implantable transvenous cardioverter defibrillators. Am Heart J 1994; 127: 1086–1089.[CrossRef][Web of Science][Medline]
[19] Marchant B, Ranjadayalan K, Stevenson R, Wilkinson P, Timis AD. Circadian and seasonal factors in the pathogenesis of acute myocardial infarction: The influence of temperature. Br Heart J 1993; 69: 385–387.
[20] Enquselassie F, Dobson AJ, Alexander HM, Steele PL. Seasons, temperature, and coronary disease. Int J Epidemiol 1993; 22: 632–636.
[21] Douglas AS, Al-Sayer H, Rawles JM, Allan TM. Seasonality of disease in Kuwait. Lancet 1991; 331: 1393–1397.
[22] Douglas AS, Dunnigan MG, Allan TM, Rawles JM. Seasonal variation in coronary heart disease in Scotland. J Epidemiol Comm Health 1995; 49: 575–582.
[23] Anderson TW and LeRiche WH. Cold weather and myocardial infarction. Lancet 1970; 1: 291–296.[Web of Science][Medline]
[24] Leor J, Poole WK, Kloner RA. Sudden cardiac death triggered by an earthquake. N Engl J Med 1996; 334: 413–419.
[25] Nishimoto Y, Firth BR, Kloner RA, Leor J, Lerman RD, Bhandari AK, Cannom DS. The 1994 Northridge earthquake triggered shocks from implantable cardioverter defibrillators (Abstr). Circulation 1995; 92: I-605.
[26] Meisel SR, Kutz I, Dayan KI, Pauzner H, Chetboun I, Arbel Y, David D. Effect of Iraqi missile war on incidence of acute myocardial infarction and sudden death in Israeli citizens. Lancet 1991; 338: 660–661.[CrossRef][Web of Science][Medline]
[27] Mittleman MA, Maclure M, Sherwood J, Mulry RP, Tofler GH, Jasobs SC, Friedman R, Benson H, Muller JE. Triggering of acute myocardial infarction onset by episodes of anger. Circulation 1995; 92: 1720–1725.
[28] Dorian P, Newman DM, Sheehan R, Tang A, Green M, Mitchell J. d-Sotalol decreases defibrillation energy requirements in humans: a novel indication for drug therapy. J Cardiovasc Electrophysiol 1996; 7: 952–961.[Web of Science][Medline]
[29] Ochi RP, Goldenberg IF, Almquist A, Pritzker M, Milstein S, Pedersen W, Gobel FL, Benditt DG. Intravenous amiodarone for the treatment of life threatening ventricular arrhythmias in critically ill patients with coronary artery disease. Am J Cardiol 1989; 64: 599–603.[CrossRef][Web of Science][Medline]
[30] Greene HL. The CASCADE study: Randomized antiarrhythmic drug therapy in survivors of cardiac arrest in Seattle. Am J Cardiol 1993; 72: 70F–74F.[CrossRef][Medline]
[31] Dolack GL. for the CASCADE investigators. Clinical predictors of implantable cardioverter-defibrillator shocks (results of the CASCADE trial). Am J Cardiol 1994; 73: 237–241.[CrossRef][Web of Science][Medline]
[32] Miller JM and Hsia HH. Management of the patient with frequent discharges from implantable cardioverter defibrillator devices. J Cardiovasc Electrophysiol 1996; 7: 278–285.[Web of Science][Medline]
[33] Marchlinski FE, Buxton AE, Kindwall EK, Miller JM, Rosentahl ME, Gottlieb CD, Bloom RB, Josephson ME. Comparison of individual and combined effects of procainamide and amiodarone in patients with sustained ventricular tachyarrhythmias. Circulation 1988; 78: 583–591.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  J. L. Sapp Venturing Into the Storm Circulation, January 29, 2008; 117(4): 456 - 457. [Full Text] [PDF]
|
|
|
|
|
|
C. Carbucicchio, M. Santamaria, N. Trevisi, G. Maccabelli, F. Giraldi, G. Fassini, S. Riva, M. Moltrasio, M. Cireddu, F. Veglia, et al. Catheter Ablation for the Treatment of Electrical Storm in Patients With Implantable Cardioverter-Defibrillators: Short- and Long-Term Outcomes in a Prospective Single-Center Study Circulation, January 29, 2008; 117(4): 462 - 469. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. H. Hohnloser, H. R. Al-Khalidi, C. M. Pratt, J. M. Brum, D. S. Tatla, P. Tchou, P. Dorian, and on behalf of the SHock Inhibition Evaluation with Electrical storm in patients with an implantable defibrillator: incidence, features, and preventive therapy: insights from a randomized trial Eur. Heart J., December 2, 2006; 27(24): 3027 - 3032. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Haverkamp Electrical storm: still a cryptogenic phenomenon? Eur. Heart J., December 2, 2006; 27(24): 2921 - 2922. [Full Text] [PDF]
|
|
|
|
 |
|
 Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) J. Am. Coll. Cardiol., September 5, 2006; 48(5): e247 - e346. [Full Text] [PDF]
|
|
|
|
 |
|
 Writing Committee Members, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Europace, September 1, 2006; 8(9): 746 - 837. [Full Text] [PDF]
|
|
|
|
|
|
L.J. Jordaens and J.M. Mekel Electrical storm in the ICD era Europace, January 1, 2005; 7(2): 181 - 183. [Full Text] [PDF]
|
|
|
|
|
|
P. Dorian, M. Borggrefe, H. R. Al-Khalidi, S. H. Hohnloser, J. M. Brum, D. S. Tatla, J. Brachmann, R. J. Myerburg, D. S. Cannom, M. van der Laan, et al. Placebo-Controlled, Randomized Clinical Trial of Azimilide for Prevention of Ventricular Tachyarrhythmias in Patients With an Implantable Cardioverter Defibrillator Circulation, December 14, 2004; 110(24): 3646 - 3654. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A. M. J. Theuns, J. C. J. Res, and L. J. Jordaens Home monitoring in ICD therapy: future perspectives Europace, January 1, 2003; 5(2): 139 - 142. [Abstract] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||