Update in Electrical Storm Therapy

Dragos Cozma, Diana Tint, Nandor Szegedi, Zoltan Sallo, L. Gellér

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Electrical storm (ES) is a major life-threatening event, which announces a possible negative outcome and poor prognosis and poses challenging questions concerning etiology and management. DATA SOURCES: A literature search was conducted through MEDLINE and EMBASE (past 30 years until the end of September 2018) using the following search terms: ES, ventricular fibrillation, ventricular tachycardia, ablation, and implantable defibrillator. Clinicaltrials.gov was also consulted for studies that are ongoing or completed. Additional articles were identified through bibliographical citations. AREA OF UNCERTAINTY: There is no homogeneous attitude, and therapeutic strategies vary widely. THERAPEUTIC ADVANCES: The aim of this review is to define the concept of ES, to review the incidence and prognostic implications, and to describe the most common strategies of therapeutic advances and trends. The management strategy should be decided after an accurate risk stratification is done in initial evaluation according to hemodynamic tolerability and presence of triggers and comorbidities. General care should be provided in an intensive cardiovascular care unit. The cornerstone of acute medical therapy used in ES is mainly represented by amiodarone and beta-blockers. Deep sedation and mechanical ventilation should provide comfort for treatment administration. First-choice drugs are benzodiazepines and short-acting analgesics. General care may also include thoracic epidural anesthesia to modulate neuroaxial efferents to the heart and to decrease sympathetic hyperactivity. We include a special focus on ablation as a reliable tool to target the mechanism of arrhythmia, finally building an up-to-date standardization. CONCLUSIONS: ES management needs a complex assessment and interpretation of a critical situation in a life-threatening condition. Optimal implantable cardioverter-defibrillator-reprogramming, antiarrhythmic drug therapy and sedation are in first-line approach. Catheter ablation is the elective therapy and plays a central key role in the treatment of ES if possible in combination with hemodynamic support.

Original languageEnglish
Pages (from-to)e257-e267
JournalAmerican journal of therapeutics
Volume26
Issue number2
DOIs
Publication statusPublished - Mar 1 2019

Fingerprint

Implantable Defibrillators
Short-Acting Analgesics
Hemodynamics
Deep Sedation
Play Therapy
Therapeutics
Catheter Ablation
Amiodarone
Epidural Anesthesia
Electromagnetic Phenomena
Anti-Arrhythmia Agents
Ventricular Fibrillation
Ventricular Tachycardia
Benzodiazepines
Artificial Respiration
MEDLINE
Intensive Care Units
Comorbidity
Cardiac Arrhythmias
Thorax

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

Update in Electrical Storm Therapy. / Cozma, Dragos; Tint, Diana; Szegedi, Nandor; Sallo, Zoltan; Gellér, L.

In: American journal of therapeutics, Vol. 26, No. 2, 01.03.2019, p. e257-e267.

Research output: Contribution to journalArticle

Cozma, D, Tint, D, Szegedi, N, Sallo, Z & Gellér, L 2019, 'Update in Electrical Storm Therapy', American journal of therapeutics, vol. 26, no. 2, pp. e257-e267. https://doi.org/10.1097/MJT.0000000000000918
Cozma, Dragos ; Tint, Diana ; Szegedi, Nandor ; Sallo, Zoltan ; Gellér, L. / Update in Electrical Storm Therapy. In: American journal of therapeutics. 2019 ; Vol. 26, No. 2. pp. e257-e267.
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