Long-Term follow-up in patients with incessant ventricular tachycardia

doi:10.1016/0002-9149(90)90360-D

The American Journal of Cardiology

Volume 66, Issue 10, 1 October 1990, Pages 831-836

https://doi.org/10.1016/0002-9149(90)90360-D Get rights and content

Abstract

Seventeen patients with coronary artery disease, idiopathic dilated cardiomyopathy or no organic heart disease who presented with incessant ventricular tachycardia (VT) were studied and followed for a mean period of 51 ± 35 months. In these patients the incessant VT included ≥3 episodes of sustained VT at a rate of ≥120 beats/min and frequent episodes of nonsustained VT over a 24-hour period. No patient had electrolyte disorder, prolonged QT interval, drug-induced arrhythmia or myocardial infarction <2 weeks old. Six patients died within 27 months of follow-up; 4 from sudden death and 2 from acute myocardial infarction. Three of the 11 surviving patients had remission of their VT within 1 week after the diagnosis of incessant VT. In 3 other patients in whom antiarrhythmic drugs were discontinued during follow-up because of adverse effects of the drugs or other medical reasons, 2 were found in remission. In the remaining 5 alive patients, deliberate attempts were made to discontinue the antiarrhythmic drugs; 4 of these patients were found in remission when the drugs were discontinued. Thus, 9 of these patients (53%) with incessant VT had remission over a mean follow-up of 55 ± 34 months after discontinuation of the antiarrhythmic drugs. The probability of remission in patients surviving incessant VT warrants trials of discontinuation of antiarrhythmic drugs in these patients.

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Cited by (26)

Cease the storm- A case report of successful stellate ganglion block in terminating refractory electrical storm
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An electrical storm also known as a ventricular tachycardia storm (VT storm) tends to recur and form a vicious cycle, eventually leading to a refractory electrical storm, refractory to electrical and pharmacological cardioversion. The treatment of refractory VT storm is challenging. Here we discuss the case of a middle-aged gentleman who presented to our emergency department 6 months apart with a refractory VT storm. When all the anti-arrhythmic agents and multiple cardioversion attempts failed in terminating the storm, we attempted ultrasound-guided stellate ganglion block. On both occasions, it successfully terminated the storm. Hence emergency physicians need to be aware of the right technique and timing of stellate ganglion block and ultrasound-guided needle tracking, as it can be a final rescue technique in treating refractory electrical storm in the emergency department.
Electrical storm in patients with Automatic Implantable Defibrillator : A single Center study
2023, Annales de Cardiologie et d'Angeiologie
Les orages rythmiques (OR) dont des urgences cardiaques absolues grevées d'une mortalité accrue à court terme. La véritable incidence des orages rythmiques chez les patients porteurs de défibrillateurs automatiques implantables (DAI) est difficile à estimer en raison de la définition hétérogène. La présentation clinique est variable et la prise en charge est multidisciplinaire.
L'objectif de l’étude est d'analyser le profil épidémiologique ainsi que l’évolution d'un groupe de patients implantés d'un DAI ayant eu des orages rythmiques détectés par la télécardiologie.
Il s'agit d'une étude observationnelle rétrospective monocentrique qui a inclus 14 patients implantés d'un DAI entre 2008 et 2021 en prévention primaire ou secondaire et suivis en télécardiologie. Tous ces patients ont eu au moins un orage rythmique détecté par la télécardiologie et authentifié par un ECG de surface.
L’âge moyen des patients au moment de survenue de l'orage rythmique était de 75,4 ± 14,5 ans avec des extrêmes allant de 49 à 101 ans. La plupart des patients (n = 11) étaient de sexe masculin. La cardiopathie ischémique était retrouvée dans la majorité des cas (n = 12). Un tiers des cas était implanté en prévention secondaire. L'orage rythmique était en rapport avec des épisodes récurrents de tachycardie ventriculaire. Aucun cas de fibrillation ventriculaire n'a été détecté. La syncope représentait la présentation clinique la plus fréquente (quatre patients). Neuf patients ont reçu des chocs internes avec un nombre moyen de quatre chocs par patient. Le facteur déclenchant était une ischémie myocardique chez quatre patients. La plupart des patients ont été pris en charge en soins intensifs cardiologiques et deux parmi eux ont été hospitalisés en réanimation.
En plus du traitement anti-arythmique par amiodarone et bêtabloquant, Neuf patients ont bénéficié d'une ablation des foyers de tachycardies ventriculaires.
La mortalité était élevée (dans la moitié des cas) en rapport avec un état de choc cardiogénique majoritairement.
Cette étude montre que les OR restent rares mais qu'ils restent associés à une mortalité élevée. La télécardiologie permet de les prendre en charge plus précocement.
Electrical storms (ES) are serious cardiac emergencies associated with increased short-term mortality. The true incidence of ES in patients with an implantable cardioverter defibrillator (ICD) is still difficult to estimate because of the heterogeneous definition. The clinical presentation is variable and its management is multidisciplinary.
The aim of the study was to analyze the epidemiological profile and evolution of a group of patients implanted with an ICD who had electrical storms detected by a home monitoring system.
This is a single-center retrospective observational study, which included 14 patients who were implanted with ICDs, for primary or secondary prevention between 2008 and 2021. All of them were followed by home monitoring. All these patients had an ES detected by home monitoring and authenticated by ECG.
The mean age of the patients at the time of onset of the electrical storm was 75.4 ± 14.5 years, with extremes ranging from 49 to 101 years. Most of patients (n = 11) were male. The majority of them had underlying ischaemic cardiomyopathy (n = 12). In a third of cases (n = 5) patients were implanted for secondary prevention. The electrical storm was related to recurrent episodes of VT. No cases of VF were detected. Syncope was the most frequent clinical presentation (four patients). Nine patients received internal shocks, with an average of four shocks per patient. The triggering factor was myocardial ischaemia in four cases. Majority of patients were managed in the cardiac intensive care unit. Two patients were admitted to the intensive care unit. In addition to anti-arrhythmic treatment with amiodarone and beta blockers. Nine patients underwent ablation of ventricular tachycardia focus. Mortality was high (in half of the cases) mainly due to a cardiogenic shock.
This study shows that OR remain rare, but are still associated with high mortality. Home monitoring makes it possible to manage them earlier.
Arrhythmic Recurrence and Outcomes in Patients Hospitalized With First Episode of Electrical Storm
2022, American Journal of Cardiology
Electrical storm (ES) is a life-threatening condition that may lead to recurrent arrhythmias, need for ventricular mechanical support, and death. The study aimed to assess the burden of arrhythmia recurrence and in-hospital outcomes of patients admitted for ES in a large urban hospital. We performed a retrospective analysis of patients admitted with ventricular arrhythmias from January 2018 to June 2021 and identified 61 patients with ES, defined as 3 or more episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF) within 24 hours. We reviewed the in-hospital outcomes and compared outcomes between patients who had no recurrence of VT/VF after the first 24 hours (34 [56%]), those with recurrence of 1 or 2 episodes of VT/VF within a 24-hour period (15 [24%]), and patients with 3 or more recurrent VT/VF events consistent with recurrent ES after the first 24 hours (12 [20%]). Patients with recurrent ES had significantly higher in-hospital mortality as compared with those with recurrent VT/VF not meeting criteria for ES or no recurrences of VT/VF (3 [25%] vs 0 [0%] vs 0 [0%]; p = 0.002). Moreover, patients with recurrent ES also had higher rates of the combined end points of ventricular mechanical support and death (7 [58%] vs 1 [6%] vs 1 [3%], p <0.001), invasive mechanical ventilation and death (10 [83%] vs 2 [13%] vs 2 [6%], p <0.001), catheter ablation or death (12 [100%] vs 7 [47%] vs 12 [35%], p <0.001) and heart transplantation and death (3 [25%] vs 2 [13%] vs 0 [0%], p = 0.018). In conclusion, patients admitted with ES have a high risk of in-hospital recurrence, associated with extremely poor outcomes.
EHRA/HRS/APHRS Expert Consensus on Ventricular Arrhythmias
2014, Heart Rhythm
Citation Excerpt :
These considerations have been discussed in detail in the preceding sections. Ventricular tachycardia/ventricular fibrillation storm represents a true medical emergency that requires a multi-disciplinary approach to care (Table 7).70,211–231 Ventricular tachycardia/ventricular fibrillation storm is generally defined as the occurrence of three or more episodes of VT or VF within 24 h, requiring either ATP or cardioversion/defibrillation.
EHRA/HRS/APHRS expert consensus on ventricular arrhythmias
2014, Journal of Arrhythmia
Citation Excerpt :
These considerations have been discussed in detail in the preceding sections. Ventricular tachycardia/ventricular fibrillation storm represents a true medical emergency that requires a multi-disciplinary approach to care (Table 7) [70,211–231]. Ventricular tachycardia/ventricular fibrillation storm is generally defined as the occurrence of three or more episodes of VT or VF within 24 h, requiring either ATP or cardioversion/defibrillation.
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.
2006, Journal of the American College of Cardiology
Citation Excerpt :
Presentation with stable VT does not in itself indicate a benign prognosis in patients with significant heart disease (131). Incessant VT, although hemodynamically stable, can be a cause of hemodynamic deterioration leading to HF (132). In patients with an ICD, the VT rate can fall below the lower rate of VT detection, causing underdetection of VT that can prevent arrhythmia termination.

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Long-Term follow-up in patients with incessant ventricular tachycardia

Abstract

Am J Cardiol

Chest

J Am Coll Cardiol

Am J Cardiol

Am Heart J

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am Heart J

Out-of-hospital cardiac arrest. Use of electrophysiologic testing in the prediction of long-term outcome

N Engl J Med

Nonischemic ventricular tachycardia. Clinical course and long-term follow-up in patients without clinically overt heart disease

Circulation

Ventricular tachycardia in a young population without overt heart disease

Circulation