Dinov Borislav, Darma Angeliki, Nedios Sotirios, Hindricks Gerhard
Department for Electrophysiology, Heart Center of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany.
Eur Heart J Acute Cardiovasc Care. 2023 Jan 27;12(1):69-73. doi: 10.1093/ehjacc/zuac160.
Electrical storm (ES) is a medical emergency that is defined as ≥ 3 separate ventricular tachycardia (VT) episodes causing ICD therapy within 24 h. Patients with ES have high risk for hospitalization, heart failure (HF) decompensation, in-hospital death. Furthermore, it is associated with significant anxiety and distress for the patients. Frequent triggers of ES are myocardial ischaemia, acute decompensation of HF, metabolic and electrolyte disorders, drug side-effects, increased sympathetic tone. Acute management of ES requires sedation, antiarrhythmic drugs and correction of the precipitating factors; although, in severe refractory cases, intubation, mechanical ventilation, and circulatory support might be necessary. Radiofrequency catheter ablation is superior than antiarrhythmic drugs to suppress the ES and is also frequently required to terminate the ES, as well as to achieve acute and long-term freedom of VT. Optimization of the ICD programming is crucial to reduce the burden of further appropriate and inappropriate shocks. Use of appropriate discrimination criteria and algorithms, ATPs and extending the detection times are important measures to reduce the burden of ES. In patients with end-stage HF, ES can be a sign of failing heart and can be refractory of treatment. In such cases, deactivation of the ICD therapy should be considered and discussed with patients and their care givers.
电风暴（ES）是一种医疗急症，定义为24小时内发生≥3次导致植入式心律转复除颤器（ICD）治疗的室性心动过速（VT）发作。ES患者住院、心力衰竭（HF）失代偿、院内死亡风险高。此外，它还会给患者带来严重的焦虑和痛苦。ES的常见诱因包括心肌缺血、HF急性失代偿、代谢和电解质紊乱、药物副作用、交感神经张力增加。ES的急性处理需要镇静、抗心律失常药物以及纠正诱发因素；不过，在严重难治性病例中，可能需要插管、机械通气和循环支持。射频导管消融在抑制ES方面优于抗心律失常药物，并且常常需要用于终止ES，以及实现VT的急性和长期缓解。优化ICD程控对于减轻进一步的恰当和不恰当电击负担至关重要。使用合适的鉴别标准和算法、抗心动过速起搏（ATP）以及延长检测时间是减轻ES负担的重要措施。在终末期HF患者中，ES可能是心脏功能衰竭的迹象，且治疗可能无效。在这种情况下，应考虑停用ICD治疗并与患者及其护理人员进行讨论。
