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Management of electrical storm – is long term antiarrhythmic therapy indicated?
International Journal of Cardiology 73 (2000) 297 www.elsevier.com / locate / ijcard
Letter to the Editor
Management of electrical storm – is long term antiarrhythmic therapy indicated? D. Vaidyanathan*, D. Prabhakar Department of Cardiology, Madras Medical College, Chennai-3, India
We are reporting a case of electrical storm [1], which was admitted in the Coronary Care Unit of the Chennai Medical College Hospital. The patient was a 41 year old male with a history of acute anterior wall myocardial infarction six years ago. His presenting manifestation was ventricular tachycardia that degenerated into ventricular fibrillation and several cardioversions (totalling 45 episodes) proved futile. In the intervening period intensive pharmacological therapy with parenteral amiodarone was started along with oral medications. One week later, he developed acaclulous cholecystitis with biochemical markers of liver dysfunction that led us to withdraw amiodarone. Repeat biochemistry and ultrasonogram one week following withdrawal of amiodarone were normal. A coronary angiogram was done which showed insignificant left anterior descending artery obstruction with moderate to severe left ventricular dysfunction. There was no evidence of left ventricular aneurysm. Three months later, he did not reveal any evidence of electrical-instability on 24 hour ambulatory ECG monitoring. One year later he continues to do well without antiarrhythmic drugs.
There is no data in medical literature about longterm management of electrical storm, although immediate results are discussed [2–4]. The long-term requirements of antiarrhythmic agents following electrical storm needs to be further evaluated.
References [1] Kowley PR. An overview of antiarrhythmic drug management of electrical storm. Canadian J of Cardiology 1996;12(Suppl B):3B– 8B. [2] Scheinman MM, Levine JH, Cannon DS, Friehling T, Kopelman HA, Chilson DA et al. Dose-ranging study of intravenous amiodarone in patients with life-threatening ventricular tachyarhythmias. The intravenous Amiodarone Multicenter Investigators Group. Circulation 1995;92:3255–63. [3] Burkart F, Pfisterer M, Kiowski W, Follath F, Burckhardt D. Effect of antiarrhythmic therapy on mortality in survivors of myocardial infarction with asymptomatic complex ventricular arrhythmias: Basal Antiarrhythmic Study of Infarct Survival (BASIS). J of Am Coll Cardiol 1990;16(7):1711–8. [4] Kowey PR, Levine JH, Herre JM, Pacifoco A, Lindsay BD, Plumb VJ et al. Randomized double-blind comparison of intravenous amiodarone and bretylium in the treatment of patients with recurrent sustained hemodynamically destabilizing ventricular tachycardia or fibrillation. The Intravenous Amiodarone Multicenter Investigators Group. Circulation 1995;92:3255–63.
*Corresponding author. Present address: No. 7, Sylvan Lodge Colony, Kilpauk, Chennai, India-600 040. E-mail address: [email protected] (D. Vaidyanathan) 0167-5273 / 00 / $ – see front matter 2000 Elsevier Science Ireland Ltd. All rights reserved. PII: S0167-5273( 00 )00227-8
Letter to the Editor
Management of electrical storm – is long term antiarrhythmic therapy indicated? D. Vaidyanathan*, D. Prabhakar Department of Cardiology, Madras Medical College, Chennai-3, India
We are reporting a case of electrical storm [1], which was admitted in the Coronary Care Unit of the Chennai Medical College Hospital. The patient was a 41 year old male with a history of acute anterior wall myocardial infarction six years ago. His presenting manifestation was ventricular tachycardia that degenerated into ventricular fibrillation and several cardioversions (totalling 45 episodes) proved futile. In the intervening period intensive pharmacological therapy with parenteral amiodarone was started along with oral medications. One week later, he developed acaclulous cholecystitis with biochemical markers of liver dysfunction that led us to withdraw amiodarone. Repeat biochemistry and ultrasonogram one week following withdrawal of amiodarone were normal. A coronary angiogram was done which showed insignificant left anterior descending artery obstruction with moderate to severe left ventricular dysfunction. There was no evidence of left ventricular aneurysm. Three months later, he did not reveal any evidence of electrical-instability on 24 hour ambulatory ECG monitoring. One year later he continues to do well without antiarrhythmic drugs.
There is no data in medical literature about longterm management of electrical storm, although immediate results are discussed [2–4]. The long-term requirements of antiarrhythmic agents following electrical storm needs to be further evaluated.
References [1] Kowley PR. An overview of antiarrhythmic drug management of electrical storm. Canadian J of Cardiology 1996;12(Suppl B):3B– 8B. [2] Scheinman MM, Levine JH, Cannon DS, Friehling T, Kopelman HA, Chilson DA et al. Dose-ranging study of intravenous amiodarone in patients with life-threatening ventricular tachyarhythmias. The intravenous Amiodarone Multicenter Investigators Group. Circulation 1995;92:3255–63. [3] Burkart F, Pfisterer M, Kiowski W, Follath F, Burckhardt D. Effect of antiarrhythmic therapy on mortality in survivors of myocardial infarction with asymptomatic complex ventricular arrhythmias: Basal Antiarrhythmic Study of Infarct Survival (BASIS). J of Am Coll Cardiol 1990;16(7):1711–8. [4] Kowey PR, Levine JH, Herre JM, Pacifoco A, Lindsay BD, Plumb VJ et al. Randomized double-blind comparison of intravenous amiodarone and bretylium in the treatment of patients with recurrent sustained hemodynamically destabilizing ventricular tachycardia or fibrillation. The Intravenous Amiodarone Multicenter Investigators Group. Circulation 1995;92:3255–63.
*Corresponding author. Present address: No. 7, Sylvan Lodge Colony, Kilpauk, Chennai, India-600 040. E-mail address: [email protected] (D. Vaidyanathan) 0167-5273 / 00 / $ – see front matter 2000 Elsevier Science Ireland Ltd. All rights reserved. PII: S0167-5273( 00 )00227-8