Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, Ancona 60126, Italy.
Cardiology Unit, "Card. G. Panico" Hospital, Via San Pio X, Tricase 73039, Italy.
Europace. 2018 Jun 1;20(6):979-985. doi: 10.1093/europace/eux166.
Electrical storm (ES) is a condition defined as three or more episodes of ventricular fibrillation (VF) or ventricular tachycardia (VT) within 24 h, and usually coexist with advanced heart failure in patients with structural heart disease. The aim of the present study is to test whether cardiac resynchronization therapy (CRT) can be associated with a lower incidence of ES.
The OBSERVO-ICD (NCT02735811) is a multicentre, retrospective registry, enrolling all consecutive patients undergoing ICD or CRT-D implantation from 2010 to 2012 in five Italian high-volume arrhythmia centres. Propensity score matching was used to compare two equally sized cohorts of ICD and CRT-D patients with similar characteristics. The primary endpoint was the time free from ES. Secondary endpoints were time free from unclustered VT/VF episodes and time free from ES in CRT-D patients according to clinical or echographic response. CRT-D was associated with a 45% relative risk reduction in ES when compared with ICD (5.6% vs. 12.3%; log rank P = 0.014). CRT-responders presented lower rates of ES when compared with non-responders and negative responders according to both clinical and echographic criteria (log-rank P = 0.017 and 0.023, respectively). No ES was detected in any of the 133 full responders to CRT-D. Clinical and echographic positive responses, but not CRT-implant per se, were associated with lower estimate rates of unclustered VTs/VFs.
Patients with CRT had a lower incidence of ES when compared with propensity-matched ICD patients. The long-term benefit of CRT seems to be due to the improved haemodynamics, as CRT-responders performed markedly better over a long-term follow-up.
电风暴（ES）是指 24 小时内发生三次或三次以上室颤（VF）或室性心动过速（VT）的情况，通常与结构性心脏病患者的晚期心力衰竭并存。本研究旨在测试心脏再同步治疗（CRT）是否可降低 ES 的发生率。
OBSERVO-ICD（NCT02735811）是一项多中心、回顾性注册研究，纳入了 2010 年至 2012 年在意大利五个大容量心律失常中心接受 ICD 或 CRT-D 植入的所有连续患者。使用倾向评分匹配比较了两组具有相似特征的 ICD 和 CRT-D 患者。主要终点是无 ES 的时间。次要终点是 CRT-D 患者根据临床或超声反应无无簇 VT/VF 发作的时间和无 ES 的时间。与 ICD 相比，CRT-D 使 ES 的相对风险降低了 45%（5.6% vs. 12.3%；对数秩 P=0.014）。根据临床和超声标准，CRT 应答者的 ES 发生率低于无应答者和阴性应答者（对数秩 P=0.017 和 0.023）。在任何 CRT-D 的 133 例完全应答者中均未检测到 ES。临床和超声阳性反应，但不是 CRT 植入本身，与无簇 VT/VF 的发生率较低有关。
与匹配倾向的 ICD 患者相比，CRT 患者的 ES 发生率较低。CRT 的长期获益似乎是由于血液动力学得到改善，因为在长期随访中，CRT 应答者的表现明显更好。
