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CLINICAL STUDIES

Electrical storm in patients with transvenous implantable cardioverter-defibrillators

Incidence, management and prognostic implications

^a Division of Cardiology, Department of Internal Medicine, J.W. Goethe University, Frankfurt, Germany

Manuscript received March 25, 1998; revised manuscript received July 16, 1998, accepted August 6, 1998.

Address for correspondence: Dr. Stefan H. Hohnloser, Division of Cardiology, Department of Medicine, J.W. Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany

Objectives. The purpose of this study was to determine the precise incidence, therapeutic options and prognostic implications of electrical storm in patients with transvenous implantable cardioverter-defibrillator (ICD) systems.

Background. Approximately 50% to 70% of patients treated with an ICD receive appropriate device-based therapy within the first 2 years. Most arrhythmic events require only one appropriate ICD firing for termination. However, some patients receive multiple appropriate shocks during a short period of time, a condition referred to as "arrhythmic or electrical storm."

Methods. This prospectively designed observational study comprised 136 recipients of transvenous ICDs who were followed for 403 ± 242 days. Electrical storm was defined as ventricular tachycardia or fibrillation resulting in device intervention 3 times during a single 24-h period.

Results. During follow-up, 57/136 patients (42%) received appropriate ICD therapy. Electrical storm occurred in 14/136 patients (10%) at an average of 133 ± 135 days after ICD implantation. The mean number of arrhythmic episodes constituting electrical storm was 17 ± 17 (range: 3 to 50; median 8) per patient. In 12 patients, electrical storm required hospital admission. The arrhythmia cluster could be terminated by a combined therapy with ß-blockers and intravenous amiodarone whereas class I antiarrhythmic drugs were only occasionally successful. The cumulative probability of survival as estimated by the Kaplan-Meier method showed that patients with an episode of electrical storm did not have a worse outcome compared to those without such an event.

Conclusions. Electrical storm represents a frequent event in patients treated with modern ICDs. It occurs most commonly late after ICD implantation and can be managed by combined therapy with ß-blockers and amiodarone. Electrical storm does not independently confer increased mortality.

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