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电风暴的病因、机制、治疗及预后

Etiologies, Mechanisms, Management, and Outcomes of Electrical Storm.

作者信息

Trohman Richard G

机构信息

Section of Electrophysiology, Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.

出版信息

J Intensive Care Med. 2024 Feb;39(2):99-117. doi: 10.1177/08850666231192050. Epub 2023 Sep 20.

Abstract

Electrical storm (ES) is characterized by three or more discrete sustained ventricular tachyarrhythmia episodes occurring within a limited time frame (generally ≤ 24 h) or an incessant ventricular tachyarrhythmia lasting > 12 h. In patients with an implantable cardioverterdefibrillator (ICD), ES is defined as three or more appropriate device therapies, separated from each other by at least 5 min, which occur within a 24-h period. ES may constitute a medical emergency, depending on the number arrhythmic episodes, their duration, the type, and the cycle length of the ventricular arrhythmias, as well as the underlying ventricular function. This narrative review was facilitated by a search of MEDLINE to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and other clinically relevant studies. The search was limited to English-language reports published between 1999 and 2023. Google and Google scholar as well as bibliographies of identified articles were reviewed for additional references. This manuscript examines the current strategies available to treat ES and compares pharmacological and invasive treatment strategies to diminish ES recurrence, morbidity, and mortality.

摘要

电风暴(ES)的特征是在有限的时间范围内(通常≤24小时)发生三次或更多次离散的持续性室性快速心律失常发作,或持续超过12小时的持续性室性快速心律失常。在植入式心律转复除颤器(ICD)患者中,ES被定义为在24小时内发生三次或更多次适当的设备治疗,每次治疗间隔至少5分钟。根据心律失常发作的次数、持续时间、类型、室性心律失常的周期长度以及潜在的心室功能,ES可能构成医疗紧急情况。本叙述性综述通过检索MEDLINE来识别同行评审的临床试验、随机对照试验、荟萃分析和其他临床相关研究得以完成。检索仅限于1999年至2023年发表的英文报告。还查阅了谷歌、谷歌学术以及已识别文章的参考文献以获取更多参考文献。本文探讨了目前可用于治疗ES的策略,并比较了药物治疗和侵入性治疗策略,以减少ES的复发、发病率和死亡率。

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