Management of electrical storm of unstable ventricular tachycardia in post myocardial infarction patients: A single centre experience

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dc.contributor.authorRao, B. Hygriven_US
dc.contributor.authorAzam, Mohammed Sadiqen_US
dc.contributor.authorManik, Geeteshen_US
dc.date.accessioned2020-01-02T06:41:11Z
dc.date.available2020-01-02T06:41:11Z
dc.date.issued2018-03
dc.description.abstractObjective 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.en_US
dc.identifier.affiliationsDivision of Cardiac Electrophysiology, Krishna Institute of Medical Sciences, Arrhythmia, Research & Training Society, Indiaen_US
dc.identifier.affiliationsDepartment of Cardiology, Krishna Institute of Medical Sciences, Indiaen_US
dc.identifier.citationRao 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): 289-295en_US
dc.identifier.issn0019-4832
dc.identifier.placeIndiaen_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/191785
dc.languageenen_US
dc.publisherCardiological Society of Indiaen_US
dc.relation.issuenumber2en_US
dc.relation.volume70en_US
dc.source.urihttps://doi.org/10.1016/j.ihj.2017.07.011en_US
dc.subjectCatheter ablationen_US
dc.subjectElectro anatomic mappingen_US
dc.subjectElectrical stormen_US
dc.subjectSubstrate modificationen_US
dc.subjectVentricular tachycardiaen_US
dc.titleManagement of electrical storm of unstable ventricular tachycardia in post myocardial infarction patients: A single centre experienceen_US
dc.typeJournal Articleen_US
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