Muser Daniele, Santangeli Pasquale, Liang Jackson J
Daniele Muser, Pasquale Santangeli, Jackson J Liang, Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, United States.
World J Cardiol. 2017 Jun 26;9(6):521-530. doi: 10.4330/wjc.v9.i6.521.
Electrical storm (ES) is a medical emergency characterized by repetitive episodes of sustained ventricular arrhythmias (VAs) in a limited amount of time (at least 3 within a 24-h period) leading to repeated appropriate implantable cardioverter defibrillator therapies. The occurrence of ES represents a major turning point in the natural history of patients with structural heart disease being associated with poor short- and long-term survival particularly in those with compromised left ventricular ejection fraction (LVEF) that can develop hemodynamic decompensation and multi-organ failure. Management of ES is challenging with limited available evidence coming from small retrospective series and a substantial lack of randomized-controlled trials. In general, a multidisciplinary approach including medical therapies such as anti-arrhythmic drugs, sedation, as well as interventional approaches like catheter ablation, may be required. Accurate patient risk stratification at admission for ES is pivotal and should take into account hemodynamic tolerability of VAs as well as comorbidities like low LVEF, advanced NYHA class and chronic pulmonary disease. In high risk patients, prophylactic mechanical circulatory support with left ventricular assistance devices or extracorporeal membrane oxygenation should be considered as bridge to ablation and recovery. In the present manuscript we review the available strategies for management of ES and the evidence supporting them.
电风暴（ES）是一种医疗急症，其特征是在有限时间内（24小时内至少3次）反复发作持续性室性心律失常（VA），导致植入式心律转复除颤器反复进行适当治疗。ES的发生是结构性心脏病患者自然病程中的一个重大转折点，与短期和长期生存率低相关，特别是在左心室射血分数（LVEF）受损的患者中，可能会出现血流动力学失代偿和多器官功能衰竭。ES的管理具有挑战性，因为来自小型回顾性系列研究的可用证据有限，且严重缺乏随机对照试验。一般来说，可能需要一种多学科方法，包括抗心律失常药物、镇静等药物治疗以及导管消融等介入方法。ES入院时准确的患者风险分层至关重要，应考虑VA的血流动力学耐受性以及低LVEF、纽约心脏协会（NYHA）高级别和慢性肺病等合并症。对于高危患者，应考虑使用左心室辅助装置或体外膜肺氧合进行预防性机械循环支持，作为通向消融和恢复的桥梁。在本手稿中，我们回顾了ES管理的可用策略及其支持证据。
