Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009;36(6):563-7.

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

Zahra Emkanjoo  1 , Narges Alihasani, Abolfath Alizadeh, Mohammad Tayyebi, Hamid Bonakdar, Hamid Barakpour, Mohammad Ali Sadr-Ameli
Affiliations

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

Zahra Emkanjoo et al. Tex Heart Inst J. 2009.

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.

PubMed Disclaimer

Figures

None
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
None
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
See this image and copyright information in PMC

References

    1. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002;346(12):877–83. - PubMed
    1. Buxton AE, Lee KL, Fisher JD, Josephson ME, Prystowsky EN, Hafley G. A randomized study of the prevention of sudden death in patients with coronary artery disease. Multicenter Unsustained Tachycardia Trial Investigators [published erratum appears in N Engl J Med 2000;342(17):1300]. N Engl J Med 1999;341(25):1882–90. - PubMed
    1. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. N Engl J Med 1997;337 (22):1576–83. - PubMed
    1. Zipes DP, Roberts D. Results of the international study of the implantable pacemaker cardioverter-defibrillator. A comparison of epicardial and endocardial lead systems. The Pacemaker-Cardioverter-Defibrillator Investigators. Circulation 1995;92(1):59–65. - PubMed
    1. Villacastin J, Almendral J, Arenal A, Albertos J, Ormaetxe J, Peinado R, et al. Incidence and clinical significance of multiple consecutive, appropriate, high-energy discharges in patients with implanted cardioverter-defibrillators. Circulation 1996;93(4):753–62. - PubMed

MeSH terms

Substances