Key result
Left ventricular ejection fraction ≤30%, age >65 years, and lack of ACE inhibitor therapy were independent predictors of electrical storm recurrences in ICD patients.
Cohort (n=955)
No
In patients with ICDs, electrical storm recurrences are common and are independently predicted by LVEF ≤ 30%, age >65 years, and lack of ACE inhibitor therapy.
Answers are grounded in this paper and cite their sources.
May aid risk stratification in ICD patients; leaves open whether ACE inhibitor therapy prevents electrical storm recurrences.
AIMS: To determine prevalence and predictors of electrical storm recurrences (ES-Rs) in patients with implantable cardioverter-defibrillators (ICDs) as electrical storms (ESs) represent serious clinical events carrying a high risk of mortality. METHODS AND RESULTS: Single-centre study analysing data of consecutive patients receiving an ICD between 1993 and 2008. Electrical storm was defined as ≥ 3 separate ventricular tachyarrhythmic (VT/VF) episodes ≤ 24 h. Nine hundred and fifty-five patients [mean left ventricular ejection fraction (LVEF) 35.7 ± 15.6%] were prospectively followed for 54.2 ± 35.5 months. In 274 of 955 patients (28.7%), 2871 VT/VF episodes were observed. One hundred and fifty-three ES episodes occurred in 63 of 955 patients (6.6%). Thirty-two of 63 patients (50.8%) experienced ≥ 2 ES episodes. Twenty-six of 32 patients (81.2%) with ES-Rs experienced the second ES episode within 1 year after the initial event. Cox regression analysis identified an LVEF ≤ 30% (OR 2.2; 95% CI 1.021-4.856; P = 0.044) and a patient's age >65 years (OR 3.5; 95% CI 1.207-10.176; P = 0.021) to be predictive for ES-Rs. Patients with angiotensin-converting enzyme (ACE) inhibitor therapy were less likely to experience ES-Rs (OR 0.39; 95% CI 0.187-0.817; P = 0.013). CONCLUSIONS: Electrical storm events are not rare in a 'real-world' patient population with ICDs (6.6% in 4.5 years). The risk for ES-Rs, especially within the first year after the initial event, is high. Left ventricular ejection fraction ≤ 30%, age >65 years, and a lack of ACE inhibitor therapy are independent predictors of ES-R.
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Streitner et al. (2010) conducted a cohort in Patients with implantable cardioverter-defibrillators (ICDs) (n=955). Risk factors (LVEF ≤ 30%, age >65 years, ACE inhibitor therapy) was evaluated on Electrical storm recurrences (ES-Rs) (OR 2.2, 95% CI 1.021-4.856, p=0.044). Left ventricular ejection fraction ≤30%, age >65 years, and lack of ACE inhibitor therapy were independent predictors of electrical storm recurrences in ICD patients.
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