Significant impact of electrical storm on mortality in patients with structural heart disease and an implantable cardiac defibrillator. (15th March 2018)

• Record Type: Journal Article
• Authors: Noda, Takashi; Kurita, Takashi; Nitta, Takashi; Chiba, Yasutaka; Furushima, Hiroshi; Matsumoto, Naoki; Toyoshima, Takeshi; Shimizu, Akihiko; Mitamura, Hideo; Okumura, Ken; Ohe, Tohru; Aizawa, Yoshifusa
• Is Part Of: International journal of cardiology. Volume 255(2018)
• Page Start: 85
• Page End: 91
• Publication Date: 2018-03-15
• Subjects: AF/AFL atrial fibrillation and/or atrial flutter -- ATP antitachycardia pacing -- CRT-D cardiac resynchronization therapy device capable defibrillation -- DCM non-ischemic dilated cardiomyopathy -- E-Storm electrical storm -- ICD implantable cardiac defibrillator -- IHD ischemic heart disease -- LVEF left ventricular ejection fraction -- VF ventricular fibrillation -- VT ventricular tachycardia; Cardiac resynchronization therapy device capable defibrillation (CRT-D) -- Electrical storm -- Implantable cardioverter defibrillator (ICD) -- Ventricular tachycardia -- Ventricular fibrillation; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2017.11.077
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Electrical storm (E-Storm), defined as multiple episodes of ventricular arrhythmias within a short period of time, is an important clinical problem in patients with an implantable cardiac defibrillator (ICD) including cardiac resynchronization therapy devices capable of defibrillation. The detailed clinical aspects of E-Storm in large populations especially for non-ischemic dilated cardiomyopathy (DCM), however, remain unclear. Objective: This study was performed to elucidate the detailed clinical aspects of E-Storm, such as its predictors and prevalence among patients with structural heart disease including DCM. Methods: We analyzed the data of the Nippon Storm Study, which was a prospective observational study involving 1570 patients enrolled from 48 ICD centers. For the purpose of this study, we evaluated 1274 patients with structural heart disease, including 482 (38%) patients with ischemic heart disease (IHD) and 342 (27%) patients with DCM. Results: During a median follow-up of 28 months (interquartile range: 23 to 33 months), E-Storm occurred in 84 (6.6%) patients. The incidence of E-Storm was not significantly different between patients with IHD and patients with DCM (log-rank p = 0.52). Proportional hazard regression analyses showed that ICD implantation for secondary prevention of sudden cardiac death ( p = 0.0001) and QRS width ( p = 0.015) were the independent risk factors for E-storm. In a comparison between patients with and without E-Storm, survival curves after adjustment for clinical characteristics showed a significant difference in mortality. Conclusion: E-Storm was associated with subsequent mortality in patients with structural heart disease including DCM. Highlights: The annual incidence of electrical storm was revealed in DCM patients as well as in IHD patients. Even after adjusted for covariates, electrical storm was significantly associated with mortality. The independent risk factors of electrical storm were clarified.