(Circulation. 2001;103:2066.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Electrical Storm Presages Nonsudden Death
The Antiarrhythmics Versus Implantable Defibrillators (AVID) Trial
From the University of Calgary, Calgary, Canada (D.E., D.G.W.); Rush Medical College and Rush-Presbyterian-St Luke’s Medical Center, Chicago, Ill (S.L.P.); the AVID Clinical Trial Center, University of Washington, Seattle, Wash (E.G.R., S.L., A.P.H.); the National Heart, Lung, and Blood Institute, Bethesda, Md (D.F.); University of Maryland Medical Center, Baltimore, Md (M.G.); University of Oklahoma Health Sciences Center, Oklahoma City, Okla (K.J.B.); and Columbia–Presbyterian Medical Center, New York, NY (J.C.).
Correspondence to Derek V. Exner, MD, 3330 Hospital Drive NW, Room G208, Calgary, AB, Canada T2N 4N1. E-mail exner{at}ucalgary.ca
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.
Key Words: defibrillation • heart failure • tachycardia • fibrillation
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