Management of electrical storm of unstable ventricular tachycardia in post myocardial infarction patients: A single centre experience
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Date
2018-03
Journal Title
Journal ISSN
Volume Title
Publisher
Cardiological Society of India
Abstract
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.
Description
Keywords
Catheter ablation, Electro anatomic mapping, Electrical storm, Substrate modification, Ventricular tachycardia
Citation
Rao B. Hygriv, Azam Mohammed Sadiq, Manik Geetesh. Management of electrical storm of unstable ventricular tachycardia in post myocardial infarction patients: A single centre experience. Indian Heart Journal. 2018 Mar; 70(2): 289-295