ELECTRICAL STORMS AND THEIR PROGNOSTIC IMPLICATIONS
Abstract
Background: Prevention of sudden cardiac death has always been a challenge for electrophysiologistsand to date, automatic implantable cardiovertor defibrillator (AICD) is found to be the only remedy.
This device delivers an intracardiac shock whenever it senses a fatal ventricular arrhythmia in order to
achieve sinus rhythm. If the delivery of these intracardiac shocks becomes frequent, the situation is
declared as an electrical storm. This article deals with the frequency, precipitating factors and
prevention of electrical storms. Methods: One hundred and ten episodes of electrical storms (a total of
668 shocks) were retrospectively analysed in 25 recipients of automatic implantable cardioverter
defibrillators. ECG, echocardiography, serum electrolytes, urea and creatinine were done for all the
patients, and they were hospitalized for a minimum of 24 hours. Results: During the 3 year study
period, all the 25 patients with an implantable cardiovertor defibrillator, on an average, received one
shock per two years. However, 12 out of these 25 patients (50%) had more than two shocks within 24
hours. Most of these patients with electrical storms were having active ischemia, electrolytes
imbalances or renal failure. Conclusion: Electrical storms are common in patients with coronary artery
disease with impaired left ventricular functions. Ischemia, electrolytes imbalances and renal failure
predispose to the electrical storms. Electrical Storms are predictors of poor prognosis.
Keywords: Electrical Storm (ES), Automatic Implantable Cardiovertor Defibrillator (AICD),
Ventricular Tachycardia (VT), Ventricular Fibrillation (VF)
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