Complex management of electrical storm in a patient with non-ischemic dilated cardiomyopathy

##plugins.themes.bootstrap3.article.main##

##plugins.themes.bootstrap3.article.sidebar##

Published Jul 2, 2017
DOI: https://doi.org/10.22551/2017.15.0402.10103
Ovidiu Mitu Mircea Balasanian Cristian Stătescu Mihaela Grecu Anca Dabija Alexandra Iovoaia Ecaterina Strîmbeanu Cătălina Arsenescu-Georgescu

Abstract

Electrical storm represents a major clinical emergency characterized by electrical heart instability with several recurrent episodes of ventricular arrhythmias over a short period of time. We present the case of a 67-year old male, hypertensive, diabetic who was referred to the cardiology department after a resuscitated cardiac arrest through sustained ventricular tachycardia. The echocardiography revealed a severe aspect of dilated cardiomyopathy and fibrotic aspect of inferior-posterior wall of the left ventricle. The ischemic coronary cause has been ruled out by coronary computed tomography. An implantable cardioverter defibrillator (ICD) was implanted. One day after, the electrical storm and hemodynamically stability worsened requiring high dosage of amiodarone, putting therapies of ICD on “off” and the intubation of the patient. Taking all into account, an urgent electrophysiological study was performed and led to complex radiofrequency catheter ablation of the substrate of the lateral, medium-ventricular wall. Afterwards, the electrical storm did not reappear, the ICD therapies were put on “on” and the patient was rapidly extubated, being discharged with pharmacological recommendations, the milestone being the anti-arrhythmic treatment. Though the treatment of electrical storm is complex but still unclearly defined, we emphasize the need of applying all the therapeutical measures and having a prompt response to this life-threatening condition.

##plugins.themes.bootstrap3.article.details##

Keywords

electrical storm, catheter ablation, implantable cardioverter defibrillator, anti-arrhythmic, ventricular tachycardia, non-ischemic dilated cardiomyopathy

References
1. Sagone A. Electrical Storm: Incidence, Prognosis and Therapy. J Atr Fibrillation 2015; 8(4):1150.
2. Maruyama M. Management of electrical storm: The mechanism matters. J Arrhythm 2014; 30:242–249.
3. Hohnloser SH, Al-Khalidi HR, Pratt CM, et al. Electrical storm in patients with an implantable defibrillator: incidence, features, and preventive therapy: insights from a randomized trial. Eur Heart J 2006; 27(24):3027-3032.
4. Conti S, Pala S, Biagioli V, et al. Electrical storm: A clinical and electrophysiological overview. World J Cardiol 2015; 7(9):555-561.
5. Sesselberg HW, Moss AJ, McNitt S, et al. Ventricular arrhythmia storms in postinfarction patients with implantable defibrillators for primary prevention indications: a MADIT-II substudy. Heart Rhythm 2007; 4(11):1395-1402.
6. Gao D, Sapp JL. Electrical storm: definitions, clinical importance, and treatment. Curr Opin Cardiol 2013; 28(1):72-79.
7. Nayyar S1, Ganesan AN, Brooks AG, Sullivan T, Roberts-Thomson KC, Sanders P. Venturing into ventricular arrhythmia storm: a systematic review and meta-analysis. Eur Heart J 2013; 34(8):560-571.
8. Priori SG, Blomström-Lundqvist C, Mazzanti A, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2015; 36(41):2793-2867.
9. Radu R, Mitu O, Nedelciuc I, Arsenescu-Georgescu C. Severe coronary spasm and poor relationship with other non-invasive methods of detecting coronary spasm. Rom J Cardiol 2014; 24(1):381-382.
10. Ciudin R. Interventional treatment in cardiac arrythmias. In Apetrei E (Ed.) Clinical Cardiology. Bucharest: Callisto Medical Ed; 2015:574-587.
11. Chen M. Ventricular tachycardia ablation and substrate modification in ICD patients with electrical storm. J Biomed Res 2015; 29(1):52-55.
12. Reddy VY, Reynolds MR, Neuzil P, et al. Prophylactic catheter ablation for the prevention of defibrillator therapy. N Engl J Med 2007; 357(26):2657-2665.
13. Kuck KH, Schaumann A, Eckardt L, et al. Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): a multicentre randomised controlled trial. Lancet 2010; 375(9708):31-40.
How to Cite
Mitu, O., Balasanian, M., Stătescu, C., Grecu, M., Dabija, A., Iovoaia, A., Strîmbeanu, E., & Arsenescu-Georgescu, C. (2017). Complex management of electrical storm in a patient with non-ischemic dilated cardiomyopathy. Archive of Clinical Cases, 4(2), Arch Clin Cases 2017; 4(2):116-123. https://doi.org/10.22551/2017.15.0402.10103
Issue
Vol. 4 No. 2 (2017): Arrhythmology
Section
Case Reports

Archive of Clinical Cases is protected by copyright and may be used in accordance with copyright and other applicable laws. Content available at www.clinicalcases.eu and our digital applications is intended for personal noncommercial use.

Authors who submit a manuscript for publication in Archive of Clinical Cases agree to the following terms: a. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) only after the final version of the manuscript was accepted and published, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). d. It is compulsory that before submission authors ensure that their work was not published in any other medical journals or pending acceptance for publication and that "Archives of Clinical Cases" is the only beneficiary at that moment if their work/case will be accepted by us.

Guidelines for linking to www.clinicalcases.eu a. The main purpose of the site linking to the Archive of Clinical Casess site should be educational. b. Links should be made to the Archive of Clinical Casess home page (www.clinicalcases.eu) or to the articles abstract. c. It is forbidden to use the Archive of Clinical Casess cover by outside organizations unless permission has been granted in advance, notifying our Secretary. d. Material owned by the Archive of Clinical Cases (including the name, logo, cover, and text) may not be used in any manner that may induce the idea or suggest that the Archive of Clinical Cases is in some way recommending a specific company, product or service. e. You must not use or allow others to access or use, all or any part of our Site or the contents and/or applications on it for commercial purposes without our permission. To seek permission to do anything prohibited by or not contained in these TERMS, or which requires our prior consent or agreement, you can contact us.

How to Cite

Mitu, O., Balasanian, M., Stătescu, C., Grecu, M., Dabija, A., Iovoaia, A., Strîmbeanu, E., & Arsenescu-Georgescu, C. (2017). Complex management of electrical storm in a patient with non-ischemic dilated cardiomyopathy. Archive of Clinical Cases, 4(2), Arch Clin Cases 2017; 4(2):116-123. https://doi.org/10.22551/2017.15.0402.10103