Key result
A protocol-driven approach involving substrate modification resulted in 83.3% of post-myocardial infarction patients surviving free of electrical storm at a mean follow-up of 32.12 months.
Why the study?
Does a protocol directed algorithm improve outcomes in post myocardial infarction patients presenting with Electrical Storm of unstable ventricular tachycardia?
Observational (n=12)
No
Does a protocol directed algorithm improve outcomes in post myocardial infarction patients presenting with Electrical Storm of unstable ventricular tachycardia?
A protocol-driven approach including substrate modification by RFA improves survival and freedom from electrical storm in post-MI patients with unstable VT.
May support protocol-driven ablation in post-MI electrical storm; hypothesis-generating and requires prospective confirmation.
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±6.48years & 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±19months 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 1year 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.
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Rao et al. (2017) conducted an observational in Electrical storm of unstable ventricular tachycardia in post myocardial infarction patients (n=12). Protocol-directed algorithm including substrate modification by EAM and RFA was evaluated on Survival free of ES recurrence. A protocol-driven approach involving substrate modification resulted in 83.3% of post-myocardial infarction patients surviving free of electrical storm at a mean follow-up of 32.12 months.
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