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(Circulation. 2008;117:456-457.)
© 2008 American Heart Association, Inc.

Editorial

Venturing Into the Storm

John Lewis Sapp, BSc, BSc (Med), MD, FRCPC

From the QEII Health Sciences Center, Halifax, Nova Scotia, Canada.

Correspondence to Dr John Lewis Sapp, QEII Health Sciences Center, Room 2501F, Halifax Infirmary Site, Halifax, NS, Canada B3H 3A7. E-mail john.sapp@cdha.nshealth.ca

Key Words: Editorials • ablation • arrhythmia • tachyarrhythmia • ventricles

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Estimates of the incidence of electrical storm (ES) range from 4% over 20.6 months of follow-up in patients with primary prophylactic implantable cardioverter-defibrillators (ICDs)¹ to 20% over 31 months of follow-up in a population with secondary prophylactic ICDs.² Although smaller observational series have not identified a clear mortality risk associated with ES,^3,4 larger and more recent series have suggested a large and significant association between repeated ventricular arrhythmic events and death, both sudden and nonsudden.^5–8 It is unclear whether this adverse outcome is a result of repeated ICD shocks or whether recurrent arrhythmias are a marker of sicker hearts that are destined to do poorly. Indeed, the mode of death after ES frequently is related to heart failure. Uncertainty has thus remained about whether interventions for ES can influence mortality beyond the acute period.⁹ In this issue of Circulation, Carbucicchio and colleagues¹⁰ describe a large series of patients who underwent catheter ablation after presenting acutely with ES refractory to antiarrhythmic medications.

Article p 462

Ninety-five patients experiencing at least 3 ICD shocks within 24 hours and a mean of 14±8 ICD shocks per day over 3.9±3.6 days despite pharmacological therapy with β-blockade in 97% and amiodarone 350±120 mg/d for 5 months in 94% were included. Eighteen percent of patients had undergone prior catheter ablation for ventricular tachycardia (VT) 16±6 months previously. Patients were brought urgently or as an emergency (within 24 hours for 50 patients [53%] who experienced marked hypotension and required intravenous inotropes) for catheter ablation with a . . . [Full Text of this Article]

This article has been cited by other articles:

				K.-H. Kuck Should Catheter Ablation be the Preferred Therapy for Reducing ICD Shocks?: Ventricular Tachycardia in Patients With an Implantable Defibrillator Warrants Catheter Ablation Circ Arrhythm Electrophysiol, December 1, 2009; 2(6): 713 - 720. [Full Text] [PDF]