High Morbidity and Mortality in Patients Admitted With a First-Episode Electrical Storm

Patients who are admitted to the hospital with a first episode of electrical storm (ES) have high morbidity and mortality rates despite existing treatment options, and those with a recurrent ES experience very poor outcomes. These findings were published in The American Journal of Cardiology.

A retrospective review of electronic health records was conducted to identify cases of ES at Virginia Commonwealth University (VCU) Health (Richmond, Virginia) between January 1, 2018, and May 31, 2021. Researchers sought to evaluate the burden of arrhythmia recurrence and in-hospital outcomes in patients admitted to VCU Health, a large urban hospital, for ES. Individuals who had been admitted with a ventricular arrhythmia were analyzed.

Recurrence of ventricular arrhythmias included sustained ventricular tachycardia (VT), which lasted for 30 seconds or longer; ventricular fibrillation (VF) or use of appropriate treatments for VT or VF, including antitachycardia pacing or shocks; and recurrence of ES, which occurred 24 hours or longer from the initial episode. In-hospital outcomes included need for sympathectomy, ventricular arrhythmia catheter ablation, invasive mechanical ventilation, left ventricular mechanical support, heart transplantation, and death.

A total of 61 patients with ES, defined as 3 or more episodes of VT or VF within 24 hours, were identified. In-hospital outcomes were compared among these patients with no recurrence of VT or VF after the first 24 hours (56%); those who experienced a recurrence of 1 or 2 episodes of VT or VF within a 24-hour period (24%); and patients with 3 or more recurrent VT or VF events, which is consistent with recurrent ES after the first 24 hours (20%).

Results of the study showed that patients with recurrent ES reported significantly higher in-hospital morality compared with those with recurrent VT or VF who did not meet the criteria for ES or those with no recurrences of VT or VF (25% vs 0% vs 0%, respectively; P =.002). Additionally, patients with recurrent ES also experienced higher rates of the combined endpoints of catheter ablation or death (100% vs 47% vs 35%, respectively; P <.001); invasive mechanical ventilation and death (83% vs 13% vs 6%, respectively; P <.001); ventricular mechanical support and death (58% vs 6% vs 3%, respectively; P <.001); and heart transplantation and death (25% vs 13% vs 0%, respectively; P =.018).

A major limitation of the analysis is the fact that it was a single-center study with a small sample size that might not have sufficient power to detect potential significant differences between the comparison arms. Additionally, the results that are generated from a single-center analysis may not be fully generalizable to different settings and practices.

“In conclusion, we found that patients admitted with a first episode electrical storm have high morbidity and mortality despite existing treatment options, and in these, patients with a recurrent electrical storm have extremely poor outcomes,” the study authors noted. “Larger, prospective studies are needed to better characterize to further strengthen our findings.”

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference  

Damonte JI, Del Buono MG, Thomas GK, et al. Arrhythmic recurrence and outcomes in patients hospitalized with first episode of electrical storm. Am J Cardiol. Published online March 30, 2022. doi:10.1016/j.amjcard.2022.02.032