Electrical Storm Presages Nonsudden Death
| Autor: | Alfred P. Hallstrom, Dean Follmann, Derek V. Exner, Ellen Graham Renfroe, Sergio L. Pinski, James Coromilas, Michael R. Gold, Scott Lancaster, Karen J. Beckman, D. George Wyse |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
Male
Tachycardia medicine.medical_specialty Defibrillation medicine.medical_treatment Electric Countershock Ventricular tachycardia Risk Assessment Risk Factors Physiology (medical) Internal medicine medicine Humans Survival rate Aged Proportional Hazards Models Fibrillation Clinical Trials as Topic Ejection fraction business.industry Cardiac Pacing Artificial Middle Aged Prognosis medicine.disease Defibrillators Implantable Surgery Survival Rate Heart failure Multivariate Analysis Ventricular Fibrillation Ventricular fibrillation Tachycardia Ventricular Cardiology Female medicine.symptom Cardiology and Cardiovascular Medicine business Anti-Arrhythmia Agents Follow-Up Studies |
| Zdroj: | Circulation. 103:2066-2071 |
| ISSN: | 1524-4539 0009-7322 |
| Popis: | Background —Electrical storm, multiple temporally related episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF), is a frequent problem among recipients of implantable cardioverter defibrillators (ICDs). However, insufficient data exist regarding its prognostic significance. Methods and Results —This analysis includes 457 patients who received an ICD in the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial and who were followed for 31±13 months. Electrical storm was defined as ≥3 separate episodes of VT/VF within 24 hours. Characteristics and survival of patients surviving electrical storm (n=90), those with VT/VF unrelated to electrical storm (n=184), and the remaining patients (n=183) were compared. The 3 groups differed in terms of ejection fraction, index arrhythmia, revascularization status, and baseline medication use. Survival was evaluated using time-dependent Cox modeling. Electrical storm occurred 9.2±11.5 months after ICD implantation, and most episodes (86%) were due to VT. Electrical storm was a significant risk factor for subsequent death, independent of ejection fraction and other prognostic variables (relative risk [RR], 2.4; 95% confidence interval [CI], 1.3 to 4.2; P =0.003), but VT/VF unrelated to electrical storm was not (RR, 1.0; 95% CI, 0.6 to 1.7; P =0.9). The risk of death was greatest 3 months after electrical storm (RR, 5.4; 95% CI, 2.4 to 12.3; P =0.0001) and diminished beyond this time (RR, 1.9; 95% CI, 1.0 to 3.6; P =0.04). Conclusions —Electrical storm is an important, independent marker for subsequent death among ICD recipients, particularly in the first 3 months after its occurrence. However, the development of VT/VF unrelated to electrical storm does not seem to be associated with an increased risk of subsequent death. |
| Databáze: | OpenAIRE |
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