| Abstract [eng] |
An electrical storm is a life-threatening syndrome that is characterized as a reccurent episodes of ventricular tachycardia or ventricular fibrillation within a relatively short period of time. The mechanism of this phenomenon remains poorly understood but it is likely influenced by a complex interplay of inciting triggers such as ischemia and electrolyte disturbances with sympathetic nervous system disturbance acting on a vulnerable structural and electrophysiologic substrate. Electrical storm can be caused by a variety of pathological conditions such as a ischaemic or non-ischaemic cardiomyopathy, inherited arrhythmia syndromes but more frequently it is seen as an acute complication of myocardial infarction. The increasing use of implantable cardioverter-defibrillator therapy is also associated with a higher incidence of electrical storm. An implantable cardioverter-defibrillator implanted for primary and secondary prevention of sudden cardiac death significantly reduces mortality, but often can be associated with disturbing frequent electrical shocks associated with appropriate or inappropriate therapy. Sympathetic nervous system activation play a key role in the initiation and maintenance of electrical storm thus autonomic modulation is a cornerstone of management. Sympathetic inhibition can be achieved with -blockers, sedation, stellate- ganglion blockade, thoracic epidural anesthesia or renal sympathetic denervation. Electrical storm treatment requires a multidisciplinary approach including implantable cardioverter-defibrillator interrogation and reprogramming to reduce recurrent shocks, management of reversible triggers such as a electrolyte abnormalities, myocardial ischemia or decompensated heart failure also antiarrhytmic drug therapy, catheter ablation, sympathetic blockade and hemodynamic support. Keywords: electrical storm, ischaemic heart disease, ventricular arrhythmia, implantable cardioverter-defibrillator. |
