Is electrical storm in ICD patients the sign of a dying heart? Outcome of patients with clusters of ventricular tachyarrhythmias

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Abstract
Background Electrical storm in patients with implanted cardioverter defibrillators (ICDs) is purported to carry an ominous prognosis. Methods and Results We retrospectively compared 40 patients with electrical storm (defined as three or more episodes of ventricular arrhythmia requiring ICD therapy in a 24 h period) with those only having isolated appropriate ICD therapy (n=57) and with patients having no or only inappropriate ICD therapy (n=125). All patients received ICDs for documented sustained VT or VF. There was no significant difference in age, sex, ejection fraction, total follow-up time, or underlying heart disease between any of the three groups. Patients who had electrical storm received their first appropriate ICD therapy 275±369 days post-implant (35% had storm as their first event) with storm occurring an average of 599±710 days post-implant. Patients had 1·5±1·0 storms in total (median=1), with 55±91 episodes per storm. There were no significant differences in actuarial survival at 5-year follow-up between the three groups. Eighty percent of storm patients were alive 5 years post-implant. Conclusion Storm is a common occurrence in ICD patients, can occur at any time during the follow-up period, and does not independently confer increased mortality.

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