Negru Alina Gabriela, Iovanovici Diana Carina, Lascu Ana, Pescariu Alexandru Silviu, Cismaru Gabriel, Crișan Simina, Ailoaei Ștefan, Bebec Diana Luiza, Streian Caius Glad, Bîrza Mariela Romina, Manzur Andrei Raul, Luca Silvia Ana, David Dana, Moșteoru Svetlana, Gaiță Dan, Luca Constantin Tudor
Cardiology II Department, Victor Babes University of Medicine and Pharmacy, 300041 Timișoara, Romania.
Rocordis Heart Center, 300278 Timișoara, Romania.
J Clin Med. 2025 Jul 29;14(15):5351. doi: 10.3390/jcm14155351.
The electrical ventricular storm (VES) is defined as multiple sustained ventricular arrhythmias arising in a short time, often refractory to standard antiarrhythmic treatment. The three pillars of the physiopathogenesis of the VES are autonomic dysfunction, triggers, and an altered ventricular substrate. Incessant or highly recurrent ventricular arrhythmia impacts the hemodynamic status by worsening heart failure and increasing mortality. A stepwise, team-based, and tailored therapeutic approach is required to stop ventricular arrhythmia and regain the hemodynamic and electric stability of the patient. The authors focused on describing all currently available therapeutic approaches for VES, intending to establish the best VES therapeutic approaches. This process involves considering the patient's specific condition, responses to previous treatments, and the potential risks and benefits of each approach. The options range from adjusting antiarrhythmic therapy to reprogramming of the ICD, sedation, epidural anaesthesia, stellate ganglia anaesthetic block, and the use of ECMO or left ventricular assist devices and radiofrequency catheter ablation. Particular attention is paid to the detailed management of genetic primary arrhythmia syndromes like long-QT syndrome, catecholaminergic polymorphic ventricular tachycardia, Brugada syndrome and Wolff-Parkinson-White syndrome, early repolarisation syndrome, right ventricular arrhythmogenic dysplasia, and idiopathic ventricular fibrillation. After overcoming the acute events of VES and obtaining hemodynamic stability, the treatment should shift toward an optimal balance of heart failure therapy, controlling the substrate by revascularisation procedures and resolving other pathology-generating ventricular arrhythmias. This article provides a comprehensive overview of ESV's current management options using the most efficient strategies known to date.
电风暴（VES）定义为短时间内出现的多次持续性室性心律失常，通常对标准抗心律失常治疗无效。VES发病机制的三大支柱是自主神经功能障碍、触发因素和心室基质改变。持续性或高度复发性室性心律失常会通过加重心力衰竭和增加死亡率来影响血流动力学状态。需要采取逐步的、基于团队的且量身定制的治疗方法来终止室性心律失常并恢复患者的血流动力学和电稳定性。作者着重描述了目前所有可用于VES的治疗方法，旨在确立最佳的VES治疗方法。这个过程涉及考虑患者的具体病情、对先前治疗的反应以及每种方法的潜在风险和益处。选择范围包括调整抗心律失常治疗、对植入式心律转复除颤器（ICD）进行重新编程、镇静、硬膜外麻醉、星状神经节麻醉阻滞，以及使用体外膜肺氧合（ECMO）或左心室辅助装置和射频导管消融。特别关注对遗传性原发性心律失常综合征的详细管理，如长QT综合征、儿茶酚胺能多形性室性心动过速、Brugada综合征和预激综合征、早期复极综合征、右心室致心律失常性心肌病以及特发性心室颤动。在克服VES的急性事件并获得血流动力学稳定后，治疗应转向心力衰竭治疗的最佳平衡，通过血管重建程序控制基质并解决其他导致室性心律失常的病理问题。本文使用迄今为止已知的最有效策略，对ESV目前的管理选择进行了全面概述。
