(Circulation. 2000;102:742.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Treating Electrical Storm
Sympathetic Blockade Versus Advanced Cardiac Life Support–Guided Therapy
From the Electrophysiology and Pacing Center, Division of Cardiology, School of Medicine, University of Southern California, Los Angeles.
Correspondence to Koonlawee Nademanee, MD, 1450 San Pablo St, Suite 5501, Los Angeles, CA 90033. E-mail nademane{at}hsc.usc.edu
Background—Electrical storm (ES), defined as recurrent multiple ventricular fibrillation (VF) episodes, often occurs in patients with recent myocardial infarction. Because treating ES according to the Advanced Cardiac Life Support (ACLS) guidelines yields a poor outcome, we evaluated the efficacy of sympathetic blockade in treating ES patients and compared their outcome with that of patients treated according to the ACLS guidelines.
Methods and Results—Forty-nine patients (36 men, 13 women, mean age 57±10 years) who had ES associated with a recent myocardial infarction were separated into 2 groups. Patients in group 1 (n=27) received sympathetic blockade treatment: 6 left stellate ganglionic blockade, 7 esmolol, and 14 propranolol. Patients in group 2 (n=22) received antiarrhythmic medication as recommended by the ACLS guidelines. Patient characteristics were similar in the 2 groups. The 1-week mortality rate was higher in group 2: 18 (82%) of the 22 patients died, all of refractory VF; 6 (22%) of the 27 group 1 patients died, 3 of refractory VF (P<0.0001). Patients who survived the initial ES event did well over the 1-year follow-up period: Overall survival in group 1 was 67%, compared with 5% in group 2 (P<0.0001).
Conclusions—Sympathetic blockade is superior to the antiarrhythmic therapy recommended by the ACLS guidelines in treating ES patients. Our study emphasizes the role of increased sympathetic activity in the genesis of ES. Sympathetic blockade-not class 1 antiarrhythmic drugs-should be the treatment of choice for ES.
Key Words: fibrillation • antiarrhythmia agents • myocardial infarction
This article has been cited by other articles:
 |
|
 |
|
  J. L. Sapp Venturing Into the Storm Circulation, January 29, 2008; 117(4): 456 - 457. [Full Text] [PDF]
|
|
|
|
 |
|
 D. C. Parrish, K. Gritman, D. M. Van Winkle, W. R. Woodward, M. Bader, and B. A. Habecker Postinfarct sympathetic hyperactivity differentially stimulates expression of tyrosine hydroxylase and norepinephrine transporter Am J Physiol Heart Circ Physiol, January 1, 2008; 294(1): H99 - H106. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Vassallo and R. G. Trohman Prescribing Amiodarone: An Evidence-Based Review of Clinical Indications JAMA, September 19, 2007; 298(11): 1312 - 1322. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. K. Gehi, D. Mehta, and J. A. Gomes Evaluation and Management of Patients After Implantable Cardioverter-Defibrillator Shock JAMA, December 20, 2006; 296(23): 2839 - 2847. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) J. Am. Coll. Cardiol., September 5, 2006; 48(5): 1064 - 1108. [Full Text] [PDF]
|
|
|
|
|
|
Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) J. Am. Coll. Cardiol., September 5, 2006; 48(5): e247 - e346. [Full Text] [PDF]
|
|
|
|
 |
|
 D. P. Zipes, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death--executive summary: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Eur. Heart J., September 1, 2006; 27(17): 2099 - 2140. [Full Text] [PDF]
|
|
|
|
 |
|
 Writing Committee Members, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Europace, September 1, 2006; 8(9): 746 - 837. [Full Text] [PDF]
|
|
|
|
|
|
S. C. Hao, D. J. Christini, K. M. Stein, P. N. Jordan, S. Iwai, O. Bramwell, S. M. Markowitz, S. Mittal, and B. B. Lerman Effect of {beta}-adrenergic blockade on dynamic electrical restitution in vivo Am J Physiol Heart Circ Physiol, July 1, 2004; 287(1): H390 - H394. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Bansch, F. Oyang, M. Antz, T. Arentz, R. Weber, J. E. Val-Mejias, S. Ernst, and K.-H. Kuck Successful Catheter Ablation of Electrical Storm After Myocardial Infarction Circulation, December 16, 2003; 108(24): 3011 - 3016. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. N. Singh More on Amiodarone-Meeting the Challenges of the Combined Epidemics of Heart Failure and Atrial Fibrillation? Journal of Cardiovascular Pharmacology and Therapeutics, September 1, 2003; 8(3): 175 - 178. [PDF]
|
|
|
|
|
|
U. N. Srivatsa, R. Ebrahimi, A. El-Bialy, and R. Y. Wachsner Electrical Storm: Case Series and Review of Management Journal of Cardiovascular Pharmacology and Therapeutics, September 1, 2003; 8(3): 237 - 246. [Abstract] [PDF]
|
|
|
|
|
|
W. G. Stevenson and K. Soejima Inside or out? Another option for incessant ventricular tachycardia J. Am. Coll. Cardiol., June 4, 2003; 41(11): 2044 - 2045. [Full Text] [PDF]
|
|
|
|
 |
|
 J. E. Burjorjee and B. Milne Propofol for electrical storm; a case report of cardioversion and suppression of ventricular tachycardia by propofol: [Le propofol et la tempete electrique; l'observation d'un cas de cardioversion et de suppression de la tachycardie ventriculaire par le propofol] Can J Anesth, November 1, 2002; 49(9): 973 - 977. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A V Ghuran and A J Camm Ischaemic heart disease presenting as arrhythmias Br. Med. Bull., October 1, 2001; 59(1): 193 - 210. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Elam and V. Macefield Multiple firing of single muscle vasoconstrictor neurons during cardiac dysrhythmias in human heart failure J Appl Physiol, August 1, 2001; 91(2): 717 - 724. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Sympathetic Blockade for Patients Experiencing 'Electrical Storm' Journal Watch Cardiology, November 9, 2000; 2000(1109): 1 - 1. [Full Text]
|
|
|
|
|
|
E. J. Rashba, M. Cooklin, K. MacMurdy, N. Kavesh, M. Kirk, S. Sarang, R. W. Peters, S. R. Shorofsky, and M. R. Gold Effects of Selective Autonomic Blockade on T-Wave Alternans in Humans Circulation, February 19, 2002; 105(7): 837 - 842. [Abstract] [Full Text] [PDF]
|
|