Objectives In the last few years awareness of ventricular electrical storm has increased. The clinical onest of ventricular electrical storm is dangerous. Electrical storm typically has a poor outcome. The mechanisms that trigger ventricular electrical storm are poorly understood. Managing its acute presentation is a challenge, and mortality is high both in the acute phase and in the long term. Here we analyse the cause and management of ventricular electrical storm.
Methods We conducted a restrospective analysis during last 5 years in our hospital. To review and assess the causes, differential diagnosis and treatment with ventricular electrical storm (VES). VES was defined by 2 or more sustained episodes of ventricular tachycardia or ventricular fibrillation within 24 hours.
Results A total of 16 cases (male 11 cases, mean age 49.6 ± 4.5 years (range from 17∼70) with ventricular electrical storm (ES) were included. Causes of ventricular ES included: Acute myocardial infarction (n = 7), Brugada syndrome (n = 1), Dilated cardiomyopathy (n = 3), Hypertrophic obstructive cardiomyopathy after percutaneous transluminal septal myocardial ablation (n = 1), Hypokalemia accompany with QT prolongation (n = 1), Acute myocarditis (n = 1), Aconitine poisoning (n = 1), Cerebral haemorrhage (n = 1). All patients were treated with electrical conversion or defibrillation emergently with averagely 4.2 times. 3 cases were died, 13 cases were survival after therapies mentioned as follows : One was treated with potassium and magnesium supplement; 5 cases were received intravenous injection of amiodarone, lidocaine and magnesium sulfate; 7 cases were resistant to the antiarrhythmic drugs mentioned above, and were successful management by intravenous injection of esmolol. After the ventricular ES subsided, 3 cases accepted ICD implantation, 11 cases treated with amiodarone and betaloc oral maintenance. None of VES recurrence were monitored during a half year follow-up.
Conclusions Ventricular electrical storm often occurs in patients who have structural heart disease, Especially in patients with myocardial ischaemia. Electrical conversion or defibrillation is the first step in order to maintain the haemodynamic stable. other management involves determining and correcting the underlying ischaemia, electrolyte imbalances, or other causative factors. Combining use of antiarrhythmic drugs is necessary, The early use of beta-blocking agent especially esmolol is essential.