Management of ventricular electrical storm: a contemporary appraisal
Autor: | Yong Mei Cha, Gurukripa N. Kowlgi |
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Rok vydání: | 2020 |
Předmět: |
medicine.medical_specialty
medicine.medical_treatment Catheter ablation Ventricular tachycardia Catecholaminergic polymorphic ventricular tachycardia Right ventricular cardiomyopathy Physiology (medical) Internal medicine medicine Humans Brugada syndrome business.industry Arrhythmias Cardiac Short QT syndrome Implantable cardioverter-defibrillator medicine.disease Defibrillators Implantable Treatment Outcome Heart failure Ventricular Fibrillation Catheter Ablation Tachycardia Ventricular cardiovascular system Cardiology Cardiology and Cardiovascular Medicine business Anti-Arrhythmia Agents |
Zdroj: | EP Europace. 22:1768-1780 |
ISSN: | 1532-2092 1099-5129 |
Popis: | Ventricular electrical storm (VES) is a clinical scenario characterized by the clustering of multiple episodes of sustained ventricular arrhythmias (VA) over a short duration. Patients with VES are prone to psychological disorders, heart failure decompensation, and increased mortality. Studies have shown that 10–28% of the patients with secondary prevention ICDs can sustain VES. The triad of a susceptible electrophysiologic substrate, triggers, and autonomic dysregulation govern the pathogenesis of VES. The rate of VA, underlying ventricular function, and the presence of implantable cardioverter-defibrillator (ICD) determine the clinical presentation. A multi-faceted approach is often required for management consisting of acute hemodynamic stabilization, ICD reprogramming when appropriate, antiarrhythmic drug therapy, and sedation. Some patients may be eligible for catheter ablation, and autonomic modulation with thoracic epidural anesthesia, stellate ganglion block, or cardiac sympathetic denervation. Hemodynamically unstable patients may benefit from the use of left ventricular assist devices, and extracorporeal membrane oxygenation. Special scenarios such as idiopathic ventricular fibrillation, Brugada syndrome, Long and short QT syndrome, early repolarization syndrome, catecholaminergic polymorphic ventricular tachycardia, arrhythmogenic right ventricular cardiomyopathy, and cardiac sarcoidosis have been described as well. VES is a cardiac emergency that requires swift intervention. It is associated with poor short and long-term outcomes. A structured team-based management approach is paramount for the safe and effective treatment of this sick cohort. |
Databáze: | OpenAIRE |
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