Management of Monomorphic Ventricular Tachycardia Electrical Storm in Structural Heart Disease

Publication date: Available online 11 May 2019Source: Journal of the Saudi Heart AssociationAuthor(s): Ahmed Said AL-Kalbani, Najib AlRawahiAbstractElectrical storm (ES) is life threatening condition that is defined by ≥3 episodes of sustained ventricular tachycardia (VT), ventricular fibrillation (VF), or appropriate shocks from an implantable cardioverter defibrillator (ICD) within 24 hours. The most common form of ES is monomorphic VT. It carries poor outcome despite all available intervention therapies. The therapies include rapid recognition of the condition, treatment of the reversible causes, ICD-reprogramming, anti-arrhythmic drugs, sedation and catheter ablation (CA). The first line anti-arrhythmic drugs are amiodarone and b-blockers with superiority of propranolol over the others. The long-term use of the anti-arrhythmic drugs is limited due to their adverse effects and drug-related proarrhythmic. The basic mechanism of monomorphic ventricular VT is re-entry pathway which can be targeted by CA. CA should be considered in drug refractory ES and patients should be referred in early course of disease. There are reported studies showed the superiority of CA over the medical treatment in reducing the arrythmia burden and ICD appropriate shocks. The survival benefit has been reported after successful ablation of ES in single center and multicenter case series but to date no randomized control trial shows mortality benefit.
Source: Journal of the Saudi Heart Association - Category: Cardiology Source Type: research