Management of electrical storm of unstable ventricular tachycardia in post myocardial infarction patients: A single centre experience
Objective: This is a case series of consecutive patients with past myocardial infarction presenting with Electrical Storm (ES) of unstable ventricular tachycardia (VT) treated by a protocol directed algorithm. Methods: Management protocol involved treatment of reversible causes, ventilatory & he...
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doaj-2f818d90b11f4a189132452cc52e51462020-11-24T22:57:12ZengElsevierIndian Heart Journal0019-48322018-03-01702289295Management of electrical storm of unstable ventricular tachycardia in post myocardial infarction patients: A single centre experienceB. Hygriv Rao0Mohammed Sadiq Azam1Geetesh Manik2Division of Cardiac Electrophysiology, Krishna Institute of Medical Sciences, Arrhythmia, Research & Training Society, India; Corresponding author.Department of Cardiology, Krishna Institute of Medical Sciences, IndiaDepartment of Cardiology, Krishna Institute of Medical Sciences, IndiaObjective: This is a case series of consecutive patients with past myocardial infarction presenting with Electrical Storm (ES) of unstable ventricular tachycardia (VT) treated by a protocol directed algorithm. Methods: Management protocol involved treatment of reversible causes, ventilatory & hemodynamic support, administration of antiarrhythmic drugs (AAD) & maximally tolerated doses of beta-blockers, stellate ganglionectomy and Radiofrequency ablation (RFA) guided by Electro Anatomic Mapping (EAM). Patients were followed up periodically with review of device data logs. Results: There were 12 patients (mean age = 61.38 ± 6.48 years & mean LVEF = 31.92 ± 4.23%). Presentation was recurrent ICD shocks (n = 5) or VT (n = 7). All were mechanically ventilated. Reversible causes were identified in 4 patients and appropriately addressed. Totally 8 patients underwent endocardial substrate modification by EAM & RFA. Endocardial LV Voltage mapping demonstrated a mean scar area of 70.04 ± 17.63 sq.cm (27.04 ± 6.20% of mapped area). The electrograms targeted for ablation included late potentials, fractionated electrograms, double potentials and channels within the scar. Two patients had stellate ganglionectomy in addition. Ten patients (83.3%) survived to discharge, all of whom are alive at a follow up of 30.12 ± 19 months free of ES. VT free survival at end of follow up was 80%. No patient had hospitalization related to VT. Single episode of VT recurrence was seen in 2 patients at 7 months and 1 year of follow up respectively. Conclusion: In post myocardial infarction patients presenting with ES and unstable VT, a protocol driven approach involving substrate modification targeting abnormal electrograms improves outcomes. Keywords: Catheter ablation, Electro anatomic mapping, Electrical storm, Substrate modification, Ventricular tachycardiahttp://www.sciencedirect.com/science/article/pii/S0019483217302912 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
B. Hygriv Rao Mohammed Sadiq Azam Geetesh Manik |
spellingShingle |
B. Hygriv Rao Mohammed Sadiq Azam Geetesh Manik Management of electrical storm of unstable ventricular tachycardia in post myocardial infarction patients: A single centre experience Indian Heart Journal |
author_facet |
B. Hygriv Rao Mohammed Sadiq Azam Geetesh Manik |
author_sort |
B. Hygriv Rao |
title |
Management of electrical storm of unstable ventricular tachycardia in post myocardial infarction patients: A single centre experience |
title_short |
Management of electrical storm of unstable ventricular tachycardia in post myocardial infarction patients: A single centre experience |
title_full |
Management of electrical storm of unstable ventricular tachycardia in post myocardial infarction patients: A single centre experience |
title_fullStr |
Management of electrical storm of unstable ventricular tachycardia in post myocardial infarction patients: A single centre experience |
title_full_unstemmed |
Management of electrical storm of unstable ventricular tachycardia in post myocardial infarction patients: A single centre experience |
title_sort |
management of electrical storm of unstable ventricular tachycardia in post myocardial infarction patients: a single centre experience |
publisher |
Elsevier |
series |
Indian Heart Journal |
issn |
0019-4832 |
publishDate |
2018-03-01 |
description |
Objective: This is a case series of consecutive patients with past myocardial infarction presenting with Electrical Storm (ES) of unstable ventricular tachycardia (VT) treated by a protocol directed algorithm. Methods: Management protocol involved treatment of reversible causes, ventilatory & hemodynamic support, administration of antiarrhythmic drugs (AAD) & maximally tolerated doses of beta-blockers, stellate ganglionectomy and Radiofrequency ablation (RFA) guided by Electro Anatomic Mapping (EAM). Patients were followed up periodically with review of device data logs. Results: There were 12 patients (mean age = 61.38 ± 6.48 years & mean LVEF = 31.92 ± 4.23%). Presentation was recurrent ICD shocks (n = 5) or VT (n = 7). All were mechanically ventilated. Reversible causes were identified in 4 patients and appropriately addressed. Totally 8 patients underwent endocardial substrate modification by EAM & RFA. Endocardial LV Voltage mapping demonstrated a mean scar area of 70.04 ± 17.63 sq.cm (27.04 ± 6.20% of mapped area). The electrograms targeted for ablation included late potentials, fractionated electrograms, double potentials and channels within the scar. Two patients had stellate ganglionectomy in addition. Ten patients (83.3%) survived to discharge, all of whom are alive at a follow up of 30.12 ± 19 months free of ES. VT free survival at end of follow up was 80%. No patient had hospitalization related to VT. Single episode of VT recurrence was seen in 2 patients at 7 months and 1 year of follow up respectively. Conclusion: In post myocardial infarction patients presenting with ES and unstable VT, a protocol driven approach involving substrate modification targeting abnormal electrograms improves outcomes. Keywords: Catheter ablation, Electro anatomic mapping, Electrical storm, Substrate modification, Ventricular tachycardia |
url |
http://www.sciencedirect.com/science/article/pii/S0019483217302912 |
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