Division of Cardiology, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Yonsei Med J. 2011 Jan;52(1):26-32. doi: 10.3349/ymj.2011.52.1.26.
In some patients with an implantable cardioverter defibrillator (ICD), multiple episodes of electrical storm (ES) can occur. We assessed the prevalence, features, and predictors of ES in patients with ICD.
Eighty-five patients with an ICD were analyzed. ES was defined as the occurrence of two or more ventricular tachyarrhythmias within 24 hours.
Twenty-six patients experienced at least one ES episode, and 16 patients experienced two or more ES episodes. The first ES occurred 209 ± 277 days after ICD implantation. In most ES cases, the index arrhythmia was ventricular tachycardia (65%). There were no obvious etiologic factors at the onset of most ES episodes (57%). More patients with a structurally normal heart (p = 0.043) or ventricular fibrillation (VF) as the index arrhythmia (p = 0.017) were in the ES-free group. Kaplan-Meier estimates and a log-rank test showed that patients with nonischemic dilated cardiomyopathy (DCMP) (log-rank test, p = 0.016) or with left ventricular ejection fraction < 35% (p = 0.032) were more likely to experience ES, and that patients with VF (p = 0.047) were less affected by ES. Cox proportional hazard regression analysis showed that nonischemic DCMP correlated with a greater probability of ES (hazard ratio, 3.71; 95% confidence interval, 1.16-11.85; p = 0.027).
ES is a common and recurrent event in patients with an ICD. Nonischemic DCMP is an independent predictor of ES. Patients with VF or with a structurally normal heart are less likely to experience ES.
在一些植入式心脏复律除颤器（ICD）患者中，可能会发生多次电风暴（ES）。我们评估了 ICD 患者 ES 的发生率、特征和预测因素。
分析了 85 例 ICD 患者。ES 定义为 24 小时内发生两次或两次以上室性心动过速。
26 例患者至少经历过一次 ES 发作，16 例患者经历过两次或两次以上 ES 发作。第一次 ES 发生在 ICD 植入后 209±277 天。在大多数 ES 病例中，起始心律失常为室性心动过速（65%）。大多数 ES 发作时没有明显的病因因素（57%）。结构性正常心脏（p=0.043）或室颤（VF）作为起始心律失常（p=0.017）的患者更可能不在 ES 组。Kaplan-Meier 估计和对数秩检验显示，非缺血性扩张型心肌病（DCMP）患者（对数秩检验，p=0.016）或左心室射血分数<35%的患者（p=0.032）更易发生 ES，而 VF 患者（p=0.047）较少受 ES 影响。Cox 比例风险回归分析显示，非缺血性 DCMP 与 ES 发生的可能性更大相关（危险比，3.71；95%置信区间，1.16-11.85；p=0.027）。
ES 是 ICD 患者常见且反复发生的事件。非缺血性 DCMP 是 ES 的独立预测因素。VF 或结构性正常心脏的患者不太可能发生 ES。
