Is catheter ablation a solution for the treatment of electrical storm in a patient with ICD in primary prevention?

Introduction: Electrical storm indicates a life-threatening clinical condition, associated with a high mortality rate. The trigger involved in the occurrence of electrical storm is only identified in 10-25% of the cases, and the most common arrhythmia is monomorphic ventricular tachycardia. In terms of ablation, recent studies show that it reduces the recurrence of electrical storms and increase the survival.
Case presentation: We report the case of a 48-year old male, hypertensive, diabetic, with ischemic dilated cardiomyopathy, with ICD implanted in the primary prevention of sudden cardiac death, presenting three internal electrical shocks in the last 24 hours. In spite of the maximum antiarrhythmic treatment, 11 episodes of ventricular tachycardia and ventricular fibrilla-tion occur within 2 hours, requiring internal electrical shock and external electrical shock for switching to sinus rhythm during patient hospitalization. In evolution, the patient experiences left ventricular failure phenomena with acute pulmonary edema and peripheral hypoperfusion, requiring inotropic support. A co-ronarography was performed, which detects subacute lesion of the circumflex artery, with pharmacologycal stent implantation. The electrophysiological study was performed with the ablation of arrhythmic substrate in sinus rhythm. Postprocedural, the patient is without any ventricular tachycardia or ventricular fibrillation, clinical status being net improved.
Case particularities:
–  the combination of ventricular polymorphic tachycardia and ventricular fibrillation in the electrical storm;
–  recurrence of electrical storm under maximal antiarrhythmic treatment (5 antiarrhythmic drugs);

  • complicated mechanisms involved in triggering electrical storm: infarct sequelae, subacute coro-nary ischaemia;
  • reduced incidence of electrical storm in ICD pati-ents implanted in primary prevention and increa-sed mortality in this patients;
  • relatively short time since ICD implantation and electrical storm;

Conclusions: Electrical storm is a life-threatening syndrome, and the mechanisms involved can be com-plicated and often unidentified, and that is why the medical management of such a patient is very difficult and so challenging, with a surprising clinical evolution. In spite of the poor prognosis of this patient being a ICD patient implanted in the primary prevention of sudden cardiac death, the therapeutic results obtained, coronary stent implantation and ablation of the arrhythmia substrate, have reduced the recurrence of the electrical storm and increased the survival at this patient, as proof, 7 months after admission, the patient is free of malignant rhythm disorders, and the clinical condition is greatly improved.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)