Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Eur Heart J Acute Cardiovasc Care. 2020 Sep;9(6):657-664. doi: 10.1177/2048872620903453. Epub 2020 Mar 20.
Electrical storm and incessant ventricular tachycardia (VT) are characterized by the clustering of episodes of VT or ventricular fibrillation (VF) and are associated with a poor prognosis. Autonomic nervous system activity influences VT threshold, and deep sedation may be useful for the treatment of VT emergencies.
We reviewed data from conscious patients admitted to our intensive care unit (ICU) due to monomorphic VT, polymorphic VT or VF at our tertiary center between 2010 and 2018.
A total of 46 conscious patients with recurrent ventricular arrhythmia, refractory to initial treatment, were referred to the ICU. The majority ( = 31) were stabilized on usual care. The remaining treatment-refractory 15 patients (57 years (range 9-74), 80% males, seven with implantable cardioverter-defibrillators) with VT/VF storm ( = 11) or incessant VT ( = 4) due to ischemic heart disease ( = 10), cardiomyopathy ( = 2), primary arrhythmia ( = 2) and one patient post valve surgery, were deeply sedated and intubated. A complete resolution of VT/VF within minutes to hours was achieved in 12 patients (80%), partial resolution in two (13%) and one (7%) patient died due to ventricular free-wall rupture. One patient with recurrent VT episodes needing repeated deep sedation developed necrotic caecum. No other major complications were seen. Thirteen (87%) patients were alive after a mean follow-up of 3.7 years.
Deep sedation was effective and safe for the temporary management of malignant VT/VF refractory to usual treatment. In emergencies, deep sedation may be widely accessible at both secondary and tertiary centers and a clinically useful bridge to definitive treatment of VT.
电风暴和无休止性室性心动过速（VT）的特征是 VT 或心室颤动（VF）发作的聚集，并且与预后不良相关。自主神经系统活动会影响 VT 阈值，深度镇静可能对 VT 紧急情况的治疗有用。
我们回顾了 2010 年至 2018 年期间，我们的三级中心因单形性 VT、多形性 VT 或 VF 而入住 ICU 的意识清醒患者的数据。
共有 46 例反复发作的室性心律失常患者被转诊至 ICU，这些患者对初始治疗有反应，其中大多数（31 例）在常规治疗下稳定。其余 15 例治疗抵抗的患者（57 岁（范围 9-74），80%为男性，7 例装有植入式心脏复律除颤器）出现 VT/VF 风暴（11 例）或无休止性 VT（4 例），病因包括缺血性心脏病（10 例）、心肌病（2 例）、原发性心律失常（2 例）和 1 例瓣膜手术后，这些患者被深度镇静并插管。12 例患者（80%）的 VT/VF 在数分钟至数小时内完全缓解，2 例（13%）部分缓解，1 例（7%）患者因心室游离壁破裂而死亡。1 例反复出现 VT 发作需要反复深度镇静的患者出现坏死盲肠。没有其他主要并发症。13 例（87%）患者在平均 3.7 年的随访后存活。
深度镇静对于治疗通常治疗抵抗的恶性 VT/VF 是有效且安全的。在紧急情况下，深度镇静可能在二级和三级中心广泛应用，是 VT 确定性治疗的一种有用的临床桥梁。
