eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
Current issue Archive Manuscripts accepted About the journal Special issues Editorial board Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank
vol. 14
Clinical research

Risk factors and prognostic role of an electrical storm in patients after myocardial infarction with an implanted ICD for secondary prevention

Wojciech Kwaśniewski, Artur Filipecki, Michał Orszulak, Witold Orszulak, Dagmara Urbańczyk, Robert Roczniok, Maria Trusz-Gluza, Katarzyna Mizia-Stec

Arch Med Sci 2018; 14, 3: 500–509
Online publish date: 2016/05/05
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
The aim of our study was to determine the risk factors for electrical storm (ES) and to assess the impact of ES on the long-term prognosis in patients after myocardial infarction (MI) with an implantable cardioverter-defibrillator (ICD) for secondary prevention of sudden cardiac death (SCD).

Material and methods
We retrospectively analyzed 416 patients with coronary artery disease after MI who had an implanted ICD for secondary prevention of SCD. Fifty (12%) patients had one or more incidents of an electrical storm – the ES (+) group. We matched the reference group of 47 patients from 366 ES (–) patients.

We analyzed 3,408 episodes of ventricular arrhythmias: 3,148 ventricular tachyarrhythmic episodes in the ES (+) group (including 187 episodes of ES) and 260 in the ES (–) group. Multivariate logistic regression showed that inferior wall MI (RR = 3.98, 95% CI: 1.52–10.41) and the absence of coronary revascularization (RR = 2.92, 95% CI: 1.18–7.21) were independent predictors of ES (p = 0.0014). During 6-year observation of 97 patients, there were 39 (40%) deaths: 25 (50%) subjects in the ES (+) group and 14 (30%) in the ES (–) group (p = 0.036). Independent predictors of death were: the occurrence of ES (HR = 1.93), older age (HR = 1.06), and lower left ventricular ejection fraction (HR = 0.95) (for all p < 0.001).

Electrical storm in patients after MI with ICD for secondary prevention is a relatively common phenomenon and has a negative prognostic significance. Myocardial infarction of the inferior wall and the absence of coronary revascularization are predisposing factors for the occurrence of an ES.


implantable cardioverter-defibrillator, electrical storm, sudden cardiac death

Kowey PR. An overview of antiarrhythmic drug management of electrical storm. Can J Cardiol 1996; 12 suppl B: 3B-8B.
Nademanee K, Taylor R, Bailey WE, Rieders DE, Kosar EM. Treating electrical storm: sympathetic blockade versus advanced cardiac life support-guided therapy. Circulation 2000; 102: 742-7.
Haverkamp W. Electrical storm: still a cryptogenic phenomenon? Eur Heart J 2006; 27: 2921-2.
Pires LA, Lehmann MH, Steinman RT, Baga JJ, Schuger CD. Sudden death in implantable cardioverter-defibrillator recipients: clinical context, arrhythmic events and device responses. J Am Coll Cardiol 1999; 33: 24-32.
Israel C, Barold S. Electrical storm in patients with an implanted defibrillator: a matter of definition. Ann Nonninvasive Electrocardiol 2007; 12: 375-82.
Mitsunori M. Management of electrical storm: the mechanism matters. J Arrhythmia 2014; 30: 242-9.
Vaseghi M, Gima J, Kannan C, et al. Cardiac sympathetic denervation in patients with refractory ventricular arrhythmias or electrical storm: intermediate and long-term follow-up. Heart Rhythm 2014; 11: 360-6.
Stuber T, Eigenmann C, Delacretaz E. Characteristics and relevance of clustering ventricular arrhytmias in defibrillator recipients. Pacing Clin Electrophysiol 2005; 28: 702-7.
Guerra F, Shkoza M, Scappini L, Flori M, Capucci A. Role of electrical storm as a mortality and morbidity risk factor and its clinical predictors: a meta-analysis. Europace 2014; 16: 347-53.
Exner DV, Pinski SL, Wyse DG, et al. Electrical storm presages nonsudden death. The antiarrhythmics versus implantable defibrillators (AVID) trial. Circulation 2001; 103: 2066-71.
Credner SC, Klingenheben T, Mauss O, Sticherling C, Hohnloser SH. Electrical storm in patients with transvenous implantable cardioverter-defibrillators: incidence, management and prognostic implications. J Am Coll Cardiol 1998; 32: 1909-5.
Greene M, Newman D, Geist M, Paquette M, Heng D, Dorian P. Is electrical storm in ICD patients the sign of a dying heart? Outcome of patients with clusters of ventricular tachyarrhythmias. Europace 2000; 2: 263-9.
Verma A, Kilicaslan F, Marrouche NF, et al. Prevalence, predictors and mortality significance of the causative arrhythmia in patients with electrical storm. J Cardiovasc Electrophysiol 2004; 15: 1265-70.
Villacastin J, Almendral J, Arenal A, et al. Incidence and clinical significance of multiple consecutive, appropriate, high-energy discharges in patients with implanted cardioverter-defibrillators. Circulation 1996; 93: 753-62.
Sesselberg HW, Moss AJ, McNitt S, et al. Ventricular arrhythmia storms in postinfarction patients with implantable defibrillators for primary prevention indications: a MADIT-II substudy. Heart Rhythm 2007; 4: 1395-402.
Wilber DJ, Kopp DE, Glascock DN, Kinder CA, Kall JG. Catheter ablation of the mitral isthmus for ventricular tachycardia associated with inferior infarction. Circulation 1995; 92: 3481-9.
Lacroix D, Klug D, Grandmougin D, Jarwe M, Kouakam C, Kacet S. Ventricular tachycardia originating from the posteroseptal process of the left ventricle with inferior wall healed myocardial infarction. Am J Cardiol 1999; 84: 181-6.
Cao JM, Fishbein MC, Han JB, et al. Relationship between regional cardiac hyperinnervation and ventricular arrhythmia. Circulation 2000; 101: 1960-9.
Komaru T, Ashikawa K, Kanatsuka H, Sekiquchi N, Suzuki T, Takishima T. Neuropeptide Y vasoconstriction in coronary microvessels in the beating canine heart. Circ Res 1990; 67: 1142-51.
Okada T, Yamada T, Murakami Y, Yoshida N, Ninomiya Y, Toyama J. Mapping and ablation of trigger premature ventricular contractions in a case of electrical storm associated with ischemic cardiomyopathy. Pacing Clin Electrophysiol 2007; 30: 440-3.
Pascale P, Schlaepfer J, Oddo M, Schaller MD, Vogt P, Fromer M. Ventricular arrhythmia in coronary artery disease: limits of a risk stratification strategy based on the ejection fraction alone and impact of infarct localization. Europace 2009; 11: 1639-46.
Mäkikallio TH, Barthel P, Schneider R, et al. Frequency of sudden cardiac death among acute myocardial infarction survivors with optimized medical and revascularization therapy. Am J Cardiol 2006; 15: 480-4.
O’Rourke RA. Role of myocardial revascularization in sudden cardiac death. Circulation 1992; 85 (Suppl I): 112-7.
Holmes DR, Davis KB, Mock MB, et al. The effect of medical and surgical treatment on subsequent sudden cardiac death in patients with coronary artery disease: a report from the Coronary Artery Surgery Study. Circulation 1986; 73: 1254-63.
Prech M, Grajek S, Marszalek A, et al. Chronic infarct-related artery occlusion is associated with a reduction in capillary density. Effects on infarct healing. Eur J Heart Fail 2006; 8: 373-80.
Abbate A, Bussani R, Biondi-Zoccai GL, et al. Persistent infarct-related artery occlusion is associated with an increased myocardial apoptosis at postmortem examination in humans late after an acute myocardial infarction. Circulation 2002; 106: 1051-4.
Abbate A, Bussani R, Biondi-Zoccai GL, et al. Infarct-related artery occlusion, tissue markers of ischaemia, and increased apoptosis in the peri-infarct viable myocardium. Eur Heart J 2005; 26: 2039-45.
Moss AJ, Hall WJ, Cannom DS, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med 1996; 335: 1933-40.
Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002; 346: 877-83.
Bardy GH, Lee KL, Mark DB, et al. Sudden Cardiac Death in Heart Failure Trial (SCD-HEFT) Investigators. Amiodaron or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005; 352: 225-37.
Guerra F, Flori M, Bonelli P, Patani F, Capucci A. Electrical storm and heart failure worsening in implantable cardiac defibrillator patients. Europace 2015; 17: 247-54.
Brigadeau F, Kouakam C, Klug D, et al. Clinical predictors and prognostic significance of electrical storm in patients with implantable cardioverter defibrillators. Eur Heart J 2006; 27: 700-7.
van Boven N, Theuns D, Bogaard K, et al. Atrial fibrillation in cardiac resynchronization therapy with a defibrillator: a risk factor for mortality, appropriate and inappropriate shocks. J Cardiovasc Electrophysiol 2013; 24: 1116-22.
Kleemann T, Hochadel M, Strauss M, Skarlos A, Seidl K, Zahn R. Comparison between atrial fibrillation-triggered implantable cerdioverter-defibrillator (ICD) shocks and shocks caused by lead failure: different impact on prognosis in clinical practice. J Cardiovasc Electrophysiol 2012; 23: 735-40.
Gatzoulis KA, Andrikopoulos GK, Apostolopoulos T, et al. Electrical storm an independent predictor of adverse long-term outcome in the era of implantable defibrillator therapy. Europace 2005; 7: 184-92.
Sweeney MO, Sherfesee L, DeGroot PJ, Wathen MS, Wilkoff BL. Differences in effects of electrical therapy type for ventricular arrhythmias on mortality in implantable cardioverter-defibrillator patients. Heart Rhytm 2010; 7: 353-60.
Powell BD, Saxon LA, Boehmer JP, et al. Survival after shock therapy in implantable cardioverter-defibrillator and cardiac resynchronization therapy – defibrillator recipients according to rhythm shocked. J Am Coll Cardiol 2013; 62: 1674-9.
Fiek M, Remp T, Fleckenstein M, Pohl T, Deiss M, Reithmann C. Incidence and relevance of nonreentrant monomorphic ventricular tachycardia in patients with frequent implantable cardioverter defibrillator interventions. J Interv Cardiac Electrophysiol 2015; 42: 151-60.
Daubert JP, Zareba W, Cannom DS, et al. Inappriopriate implantable cardioverter-defibrillator shocks in MADIT II: frequency, mechanisms, predictors, and survival impact. J Am Coll Cardiol 2008; 51: 1357-65.
Poole JE, Johnson GW, Hellkamp AS, et al. Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med 2008; 359: 1009-17.
Joglar JA, Kessler DJ, Welch PJ, et al. Effects of repeated electrical defibrillations on cardiac troponin I levels. Am J Cardiol 1999; 83: 270-2.
Epstein AE, Kay GN, Plumb VJ, Dailey SM, Anderson PG. Gross and microscopic pathological changes associated with nonthoracotomy implantable defibrillator leads. Circulation 1998; 98: 1517-24.
Tsuji Y, Hojo M, Voigt N, et al. Ca(2+)-related signaling and protein phosphorylation abnormalities play central roles in a new experimental model of electrical storm. Circulation 2011; 123: 2192-203.
Stöckigt F, Peche V S, Linhart M, et al. Deficiency of cyclase-associated protein 2 promotes arrhythmias associated with connexin43 maldistribution and fibrosis. Arch Med Sci 2016; 12: 188-98.
Bogun F, Good E, Reich S, et al. Role of Purkinje fibers in post-infarction ventricular tachycardia. J Am Coll Cardiol 2006; 48: 2500-7.
Quick links
© 2019 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe