Electrical storm in patients with implantable cardioverter-defibrillators: can it be forecast?

Abstract

The aim of this retrospective study was to determine the prevalence and predictors of electrical storm in 227 patients who had received implantable cardioverter-defibrillators (ICDs) and had been monitored for 31.7 +/- 15.6 months. Of these, 174 (77%) were men. The mean age was 55.8 +/- 15.5 years (range, 20-85 yr), and the mean left ventricular ejection fraction (LVEF) was 0.30 +/- 0.14. One hundred forty-six of the patients (64%) had underlying coronary artery disease. Cardioverter-defibrillators were implanted for secondary (80%) and primary (20%) prevention. Of the 227 patients, 117 (52%) experienced events that required ICD therapy. Thirty patients (mean age, 57.26 +/- 14.3 yr) had > or = 3 episodes requiring ICD therapy in a 24-hour period and were considered to have electrical storm. The mean number of events was 12.75 +/- 15 per patient. Arrhythmia-clustering occurred an average of 6.1 +/- 6.7 months after ICD implantation. Clinical variables with the most significant association with electrical storm were low LVEF (P = 0.04; hazard ratio of 0.261, and 95% confidence interval of 0.08-0.86) and higher use of class IA antiarrhythmic drugs (P = 0.018, hazard ratio of 3.84, and 95% confidence interval of 1.47-10.05). Amiodarone treatment and use of beta-blockers were not significant predictors when subjected to multivariate analysis. We conclude that electrical storm is most likely to occur in patients with lower LVEF and that the use of Class IA antiarrhythmic drugs is a risk factor.

Keywords: Antiarrhythmia agents; arrhythmias, cardiac/prevention & control; cardiac pacing, artificial; defibrillators, implantable; electric countershock; electrical storm; heart failure; tachycardia, ventricular/therapy; ventricular dysfunction, left.

Fig. 2. Kaplan-Meier curve depicting the time to 1st electrical storm in association with use or nonuse of Class IA antiarrhythmic drugs, in patients at risk of electrical storm. AAD = antiarrhythmic drugs

Fig. 1. Kaplan-Meier curve depicting the time to 1st electrical storm in association with left ventricular ejection fraction (<0.35 or ≥0.35), in patients at risk of electrical storm. LVEF = left ventricular ejection fraction