背景:电风暴(ES)是与短期死亡率增加相关的严重心脏紧急情况。由于定义不一致,因此仍难以估计植入心脏复律除颤器(ICD)的患者中ES的真实发生率。临床表现是可变的,其管理是多学科的。
目的:本研究的目的是分析一组植入ICD的患者的流行病学概况和演变,这些患者通过家庭监测系统检测到有电风暴。
方法:这是一项单中心回顾性观察研究,其中包括14名植入ICD的患者,在2008年至2021年之间进行一级或二级预防。所有这些都是家庭监控。所有这些患者均通过家庭监测检测到ES,并通过ECG进行身份验证。
结果:电风暴发作时患者的平均年龄为75.4±14.5岁,极端情况从49年到101年不等。大多数患者(n=11)为男性。他们中的大多数患有潜在的缺血性心肌病(n=12)。在三分之一的病例(n=5)中,患者被植入进行二级预防。电风暴与VT的反复发作有关。未检测到VF病例。晕厥是最常见的临床表现(4例)。九名患者接受了内部电击,每个患者平均4次电击。4例患者的触发因素为心肌缺血。大多数患者在心脏重症监护病房接受治疗。两名患者被送往重症监护病房。除了胺碘酮和β受体阻滞剂的抗心律失常治疗。9例患者接受了室性心动过速病灶消融。死亡率很高(在一半的病例中),主要是由于心源性休克。
结论:这项研究表明OR仍然很罕见,但仍然与高死亡率相关。家庭监控可以更早地管理它们。
BACKGROUND: Electrical storms (ES) are serious cardiac emergencies associated with increased short-term mortality. The true incidence of ES in patients with an implantable cardioverter defibrillator (ICD) is still difficult to estimate because of the heterogeneous definition. The clinical presentation is variable and its management is multidisciplinary.
OBJECTIVE: The aim of the
study was to analyze the epidemiological profile and evolution of a group of patients implanted with an ICD who had electrical storms detected by a home monitoring system.
METHODS: This is a single-center retrospective observational
study, which included 14 patients who were implanted with ICDs, for primary or secondary prevention between 2008 and 2021. All of them were followed by home monitoring. All these patients had an ES detected by home monitoring and authenticated by ECG.
RESULTS: The mean age of the patients at the time of onset of the electrical storm was 75.4 ± 14.5 years, with extremes ranging from 49 to 101 years. Most of patients (n = 11) were male. The majority of them had underlying ischaemic cardiomyopathy (n = 12). In a third of cases (n = 5) patients were implanted for secondary prevention. The electrical storm was related to recurrent episodes of VT. No cases of VF were detected. Syncope was the most frequent clinical presentation (four patients). Nine patients received internal shocks, with an average of four shocks per patient. The triggering factor was myocardial ischaemia in four cases. Majority of patients were managed in the cardiac intensive care unit. Two patients were admitted to the intensive care unit. In addition to anti-arrhythmic treatment with amiodarone and beta blockers. Nine patients underwent ablation of ventricular tachycardia focus. Mortality was high (in half of the cases) mainly due to a cardiogenic shock.
CONCLUSIONS: This
study shows that OR remain rare, but are still associated with high mortality. Home monitoring makes it possible to manage them earlier.