Refractory electrical storm in coronary artery disease patient, challenges of dying heart
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Abstract
Electrical storm most often occurs in patients with coronary artery disease and left ventricular dysfunction. We report a case of recurrent ventricular Tachycardia (VT) in a 49-year-old male patient previously known to have an inferior myocardial infarction and hypertension, presented with ischemic chest pain accompanied by dizziness, hypotension, and tachycardia. An electrocardiogram showed monomorphic VT. A prompt synchronized electrical cardioversion under sedation has reverted the rhythm to the sinus. An echocardiogram showed left ventricular segmental wall motion abnormalities and ejection fraction of 37%. Then the condition complicated by recurrent VT necessitates multiple electrical cardioversions and defibrillation given for recurrent ventricular Fibrillation (VF) and short cardiopulmonary resuscitations that revived the patient from cardiac arrests. The patient had received a total of 103 electrical shocks over 15 days during which, he developed circulatory and respiratory compromise that required mechanical ventilation on twice occasions. Meticulous care including central monitoring and inotrope for hypotensive episodes was provided. A coronary angiogram showed normal left anterior descending and circumflex coronary arteries and a totally occluded right coronary artery which was failed to be revascularized in an attempt of angioplasty. The patient was successfully weaned off the ventilator and run a quiet course afterward. An implantable cardioverter-defibrillator was placed while maintained on oral amiodarone, mexiletine, metoprolol, and omega-3-acid ethyl esters, then discharged asymptomatic without recorded dysrhythmias. This case report underscores the challenges encountered throughout the management of such particular life-threatening ventricular arrhythmias and their impact on patient safety.
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Andreson D, Bethge KP, Boissel JP, von Leitner ER, Peyrieux JC, et al. (1990) Importance of quantitative analysis of ventricular arrhythmias for predicting the prognosis in low-risk postmyocardial infarction patients. European Infarction Study Group. Eur Heart J. 11: 529–536. Link: https://bit.ly/3ImvVUM
Wilber D, Wojciech Z, Hall WJ, Brown MW, Lin AC, et al. (2004) Time dependence of mortality risk and defibrillator benefit after myocardial infarction. Circulation 109: 1082-1084. Link: https://bit.ly/3AoguJ3
Marill KA, deSouza IS, Nishijima DK, Stair TO, Setnik GS, et al. (2006) Amiodarone is poorly effective for the acute termination of ventricular tachycardia. Ann Emerg Med 47: 217-224. Link: https://bit.ly/32li6Xp
Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, et al. (2006) ACC/AHA//ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Circulation 144: e385–e484. Link: https://bit.ly/3qMzL3M
Dorian P, Cass D, Schwartz B, Cooper R, Gelaznikas R, et al. (2002) Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med 346: 884–890. Link: https://bit.ly/3nKdUrW
Marill KA, deSouza IS, Nishijima DK, Stair TO, Setnik GS, et al. (2006) Amiodarone is poorly effective for the acute termination of ventricular tachycardia. Ann Emerg Med 47: 217-224. Link: https://bit.ly/3nKdUbq
Tomlinson DR, Cherian P, Betts TR, Bashir Y (2008) Intravenous amiodarone for the pharmacological termination of haemodynamically-tolerated sustained ventricular tachycardia: is bolus dose amiodarone an appropriate first-line treatment? Emerg Med J 25: 15-18. Link: https://bit.ly/3tPzb75
Schutzenberger W, Leisch F, Kerschner K, Harringer W, Herbinger W (1989) Clinical efficacy of intravenous amiodarone in the short-term treatment of recurrent sustained ventricular tachycardia and ventricular fibrillation. Br Heart J 62: 367-371. Link: https://bit.ly/33DELyV
Washizuka T, Chinushi M, Watanabe H, Hosaka Y, Komura S, et al. (2005) Nifekalant hydrochloride suppresses severe electrical storm in patients with malignant ventricular tachyarrhythmias. Circ J 69: 1508-1513. Link: https://bit.ly/3rCXxOV
Grmec S, Mally S (2006) Vasopressin improves outcome in out-of-hospital cardiopulmonary resuscitation of ventricular fibrillation and pulseless ventricular tachycardia: An observational cohort study. Crit Care 10: R13. Link: https://bit.ly/3ImvU3a
Kudenchuk PJ, Cobb LA, Copass MK, Cummins RO, Doherty AM, et al. (1999) Amiodarone for resuscitation after out of-hospital cardiac arrest due to ventricular fibrillation. N Engl J Med 341: 871-878. Link: https://bit.ly/3nNcdKl
Rossi PR, Yusuf S, Ramsdale D, Furze L, Sleight P (1983) Reduction of ventricular arrhythmias by early intravenous atenolol in suspected acute myocardial infarction. BMJ (Clin Res Ed) 286: 506-510. Link: https://bit.ly/3nMRh68
Ryden L, Ariniego R, Arnman K, Herlitz D, Hjalmarson A, et al. (1983) A double-blind trial of metoprolol in acute myocardial infarction. Effect on ventricular tachyarrhythmias. N Engl J Med 308: 614-618. Link: https://bit.ly/3KAb2ra
Boutitie F, Boissel JP, Connolly SJ, Camm AJ, Cairns JA, et al. (1999) Amiodarone interaction with beta-blockers: analysis of the merged EMIAT (European Myocardial Infarct Amiodarone Trial) and CAMIAT (Canadian Amiodarone Myocardial Infarction Trial) databases. The EMIAT and CAMIAT Investigators. Circulation 99: 2268-2275. Link: https://bit.ly/35ij0Fv
Nademanee K, Taylor R, Bailey WE, Rieders DE, Kosar EM (2000) Treating electrical storm: sympathetic blockade versus advanced cardiac life support-guided therapy. Circulation 102: 742-747. Link: https://bit.ly/3tPBYgW
Curtis JP, Sokol SI, Wang Y, Rathore SS, Ko DT, et al. (2003) The association of left ventricular ejection fraction, mortality, and cause of death in stable outpatients with heart failure. J Am Coll Cardiol 42: 736-742. Link: https://bit.ly/3tPK0Gr
Caruso AC, Marcus FI, Hahn EA, Hartz VL, Mason JW (1997) Predictors of arrhythmic death in the ESVEM trial. Electrophysiologic Study Versus Electromagnetic Monitoring. Circulation 96: 1888-1892. Link: https://bit.ly/3AjRTFn
Solomon SD, Anavekar N, Skali H, McMurray JJ,, Swedberg K, et al. (2005) Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients. Circulation 112: 3738-3744. Link: https://bit.ly/3AoIOLe
Connolly SJ, Hallstrom AP, Cappato R, Schron EB, Kuck KH, et al. (2000) Meta-analysis of the implantable cardioverter defibrillator secondary prevention trials. Eur Heart J 21: 2071-2207. Link: https://bit.ly/3fMSMgk
Reddy VY, Reynolds MR, Neuzil P, Richardson AW, Taborsky M, et al. (2007) Prophylactic catheter ablation for the prevention of defibrillator therapy. N Engl J Med 357: 2657–2665. Link: https://bit.ly/33XZI7k
Venkataraman G, Strickberger SA (2011) The role of ventricular tachycardia ablation in the reduction of implantable defibrillator shocks. Heart Fail Clin 7: 207-213. Link: https://bit.ly/3IxMxt7
Aizawa Y, Abe A, Ohira K, Furushima H, Chinushi M, et al. (1996) Preferential action of mexiletine on central common pathway of reentrant ventricular tachycardia. J Am Coll Cardiol 28:1759-1764. Link: https://bit.ly/3nMN1DD
Moak JP, Smith RT, Garson A (1987) Mexiletine: An Effective Antiarrhythmic Drug for Treatment of Ventricular Arrhythmias in Congenital Heart Disease. J Am Coll Cardiol 10: 824-829. Link: https://bit.ly/3nNL0XN