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Yartsev A, Scott A. Massive lignocaine overdose while on veno-arterial extracorporeal membrane oxygenation (VA ECMO). Toxicol Rep 2024; 12:463-468. [PMID: 38699074 PMCID: PMC11063992 DOI: 10.1016/j.toxrep.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 05/05/2024] Open
Abstract
We present the extraordinary circumstance of a female patient in her sixties who suffered a massive lignocaine overdose while undergoing treatment with Veno-Arterial Extracorporeal Membrane Oxygenation (VA ECMO) following an emergency coronary artery bypass graft (CABG). The patient was initially admitted to the Intensive Care Unit (ICU) due to unstable angina and a history of insulin-dependent type two diabetes mellitus, hypertension, hypercholesterolemia, carotid artery stenosis, and an extensive smoking history. Despite initial improvements following surgery, she experienced repeated episodes of nonsustained polymorphic ventricular tachycardia (VT) that were refractory to conventional antiarrhythmic medications. The overdose occurred due to a medication administration error, leading to the infusion of lignocaine at a rate eight times higher than intended, over the course of 36 h (total dose of 9964 mg, or 153 mg/kg). Remarkably, the patient remained haemodynamically stable throughout the overdose period, with normal sinus rhythm, requiring minimal ECMO support and no vasoactive agents. Further investigation into the pharmacokinetics of lignocaine during VA ECMO treatment suggested that the patient's unexpected stability and survival could be attributed to the adsorption of lignocaine onto the components of the ECMO circuit. This phenomenon potentially mitigated the cardiotoxic effects typically associated with such high doses of lignocaine, thus presenting an unusual but critical aspect of pharmacokinetics in the context of ECMO support. This case underscores the importance of investigating the complex interactions between medications and extracorporeal circuits, which can significantly alter drug pharmacokinetics and toxicity profiles.
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Affiliation(s)
- Alex Yartsev
- Westmead Hospital, Sydney, Australia
- Westmead ICU, Westmead Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
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2
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Rahman I, Sohail M. The Mystery of Electrical Storm: A Case Report. Cureus 2024; 16:e57202. [PMID: 38681470 PMCID: PMC11056203 DOI: 10.7759/cureus.57202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
Electrical storm is a cardiac emergency, defined as three or more hemodynamically unstable ventricular tachyarrythmias within 24 hours or ventricular tachycardia reoccurring within five minutes. The trigger for an electrical storm can be reversible like drug toxicity and electrolyte imbalances or can be irreversible like structural heart disease. Symptomatic patients can have chest pain, palpitations or syncopal episodes. We present a case of a gentleman in his 60s who was diagnosed with electrical storm which started as an out-of-hospital cardiac arrest. Uniqueness in the case lies in the unknown aetiology after all the investigations came back as normal and management of such cases is based on pacemakers and use of antiarrythmic agents to control and prevent further attacks.
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Affiliation(s)
- Imaad Rahman
- Emergency Department, East Lancashire Teaching Hospitals, Blackburn, GBR
| | - Muhammad Sohail
- Emergency Department, East Lancashire Teaching Hospitals, Blackburn, GBR
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3
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Han C, Qiu R, Li L, Han M, Xu C, Liu L, Liu C. Electrical storm refractory multiple antiarrhythmic medications was stopped by interatrial shunting procedure—A case report. Front Cardiovasc Med 2022; 9:1012916. [DOI: 10.3389/fcvm.2022.1012916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
Electrical storm (ES) remains a major dilemma for clinicians, often presenting as a medical emergency associated with significant adverse outcomes. The mechanisms behind triggering ES are complex. Although the increased activation of the sympathetic nervous system was widely accepted as a major mechanism in initiating and maintaining ES, it's thought that the interaction between mechanical and electrical substrates may play an important role in some situations. Here we present a case of ES that was refractory to multiple antiarrhythmic medications but was stopped by interatrial shunting. We aim to highlight the importance of mechano-electric feedback (MEF) as the pathophysiological mechanisms of some types of ES and the utility of interatrial shunting as an alternative therapeutic strategy for patients with ES initially refractory to antiarrhythmic medications when there is evidence to indicate increased left ventricular filling pressure or left atrial pressure.
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4
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Abstract
Purpose of Review Cardiac arrhythmias are known complications in patients with COVID-19 infection that may persist even after recovery from infection. A review of the spectrum of cardiac arrhythmias due to COVID-19 infection and current guidelines and assessment or risk and benefit of management considerations is necessary as the population of patients infected and covering from COVID-19 continues to grow. Recent Findings Cardiac arrhythmias such as atrial fibrillation, supraventricular tachycardia, complete heart block, and ventricular tachycardia occur in patients infected, recovering and recovered from COVID-19. Summary Personalized care while balancing risk/benefit of medical or invasive therapy is necessary to improve care of patients with arrhythmias. Providers must provide thorough follow-up care and use necessary precaution while caring for COVID-19 patients.
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Affiliation(s)
- Amar D Desai
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Brian C Boursiquot
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Lea Melki
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA. .,Cardiology and Cardiac Electrophysiology, Columbia University, 177 Fort Washington Avenue, New York, NY, 10032, USA.
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5
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Wu TC, Sacilotto L, Darrieux FCDC, Pisani CF, Melo SLD, Hachul DT, Scanavacca M. QT Interval Control to Prevent Torsades de Pointes during Use of Hydroxychloroquine and/or Azithromycin in Patients with COVID-19. Arq Bras Cardiol 2020; 114:1061-1066. [PMID: 32638906 PMCID: PMC8416123 DOI: 10.36660/abc.20200389] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Tan Chen Wu
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Luciana Sacilotto
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Cristiano Faria Pisani
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Sissy Lara de Melo
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Denise Tessariol Hachul
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Mauricio Scanavacca
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Pradhan S, Gresa K, Trappe HJ. Anomalous right coronary artery with interarterial course depicting an unusual case of an electrical storm: a case presentation. BMC Cardiovasc Disord 2020; 20:192. [PMID: 32321432 PMCID: PMC7178970 DOI: 10.1186/s12872-020-01486-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/14/2020] [Indexed: 11/14/2022] Open
Abstract
Background The condition of anomalous aortic origin of the right coronary artery (AAORCA) with an interarterial course leads to few, if any, clinical problems. Malignant presentation of the often non-significant AAORCA associated with conduction system abnormalities is a rare finding. Surgical repair, even for highly symptomatic patients, is still controversial. However, in this case, the surgery brought a paradigm shift in treatment modality, improving the symptoms of this patient. Case presentation We report a case of a 52-year-old man with severe chest pain and recurrent electrical storms with an implanted cardiac resynchronization therapy defibrillator (CRT-D) device. Coronary angiography and computed tomography (CT) revealed the rare anomalous aortic origin of the right coronary artery (AAORCA) with a high interarterial course between the aorta and the pulmonary trunk. As symptoms typically develop on exertion, placing the patient at an increased risk of ischemic distress, a stress myocardial perfusion imaging study helped to identify his high-risk status. Although patient-specific, a surgical repair was the only concrete step agreed upon after multiple collaborative discussions with the cardiac surgeons. Surgery significantly improved the symptoms, with the patient reporting resolution of his chest pain, as well as no documented inappropriate defibrillator activity on follow-up appointments. Conclusion One purpose of reporting the case study was to underscore the risk factors associated with AAORCA, challenging claims of its benign nature. This case complements existing findings demonstrating that ischemic distress consequent to the right coronary artery (RCA) compression may precede the rare incidence of an electrical storm. Importantly, the case-study emphasizes the significance of integrated multimodality imaging in clinical practice as well as providing real-world evidence for the efficacy of surgical repair in highly symptomatic patients with AAORCA with an interarterial course.
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Affiliation(s)
- Snehasis Pradhan
- Department of Cardiology and Angiology, Marien Hospital Herne, Ruhr- University of Bochum, Hoelkeskampring 40, 44625, Herne, Germany.
| | - Kciku Gresa
- Department of Cardiology and Angiology, Marien Hospital Herne, Ruhr- University of Bochum, Hoelkeskampring 40, 44625, Herne, Germany
| | - Hans-Joachim Trappe
- Department of Cardiology and Angiology, Marien Hospital Herne, Ruhr- University of Bochum, Hoelkeskampring 40, 44625, Herne, Germany
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7
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Aroke EN, Nkemazeh RZ. Perianesthesia Implications and Considerations for Drug-Induced QT Interval Prolongation. J Perianesth Nurs 2020; 35:104-111. [PMID: 31955897 DOI: 10.1016/j.jopan.2019.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/21/2019] [Accepted: 09/21/2019] [Indexed: 12/19/2022]
Abstract
Prolongation of the QT interval can predispose patients to fatal arrhythmias such as torsade de pointes. While arrhythmias can occur spontaneously in patients with a genetic predisposition, drugs such as ondansetron and droperidol, which are frequently used in the perioperative period, have been implicated in the prolongation of the QT interval. As the list of medications that cause QT prolongation grows, anesthesia providers and perioperative nurses must be informed regarding the importance of the QT interval. This article reviews the physiology and measurement of the QT interval, the risk factors of QT prolongation, the mechanism of drug-induced QT prolongation, and perioperative considerations for patient care.
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Affiliation(s)
- Edwin N Aroke
- Nurse Anesthesia Track, School of Nursing, The University of Alabama at Birmingham, Birmingham, AL.
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Ohsawa S, Isono H, Ojima E, Toyama M, Kuroda Y, Watanabe S, Abe T. Electrical storm 11 days after acute myocardial infarction: a case report. J Med Case Rep 2019; 13:346. [PMID: 31771621 PMCID: PMC6880439 DOI: 10.1186/s13256-019-2267-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 09/22/2019] [Indexed: 11/24/2022] Open
Abstract
Background The definition of electrical storm is still debated. For example, an electrical storm is defined as a clustering of three or more separate episodes of ventricular tachycardia/ventricular fibrillation within 24 hours or one or more episodes occurring within 5 minutes of termination of the previous episode of ventricular tachycardia/ventricular fibrillation. When it is refractory to medications, prompt assessments by coronary angiography, sedation, and overdrive pacing should be performed. An electrical storm may occur anytime, including at night or after the patient leaves an intensive care unit. Case presentation A 70-year-old Japanese man with type 2 diabetes mellitus was diagnosed as having ST-elevation myocardial infarction. His clinical course after an urgent percutaneous coronary intervention was uneventful, but he developed electrical storm that was refractory to antiarrhythmic medications on day 11 of hospitalization. We used sedative medications and performed ventricular overdrive pacing and transferred him to a university hospital for further treatment, which included electrical ablation and cardioverter-defibrillator implantation. Conclusion An electrical storm is a relatively rare and fatal complication of acute myocardial infarction. It is important that the treatment choices for this condition are known by non-cardiologist physicians who might encounter this rare condition.
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Affiliation(s)
- Sayaka Ohsawa
- Department of Internal Medicine, Kitaibaraki City Hospital, 1050 Sekimotoshita, Sekinan, Kitaibaraki, Ibaraki, Japan. .,Department of General Medicine and Primary Care, Tsukuba University Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
| | - Hiroki Isono
- Department of General Medicine and Primary Care, Tsukuba University Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Eiji Ojima
- Department of Cardiology, Mito Kyodo General Hospital, 3-2-7 Miyamachi, Mito, Ibaraki, Japan
| | - Masahiro Toyama
- Department of Cardiology, Mito Kyodo General Hospital, 3-2-7 Miyamachi, Mito, Ibaraki, Japan
| | - Yasuhisa Kuroda
- Department of Cardiology, Mito Kyodo General Hospital, 3-2-7 Miyamachi, Mito, Ibaraki, Japan
| | - Shigeyuki Watanabe
- Department of Cardiology, Mito Kyodo General Hospital, 3-2-7 Miyamachi, Mito, Ibaraki, Japan
| | - Toshikazu Abe
- Department of General Medicine, Juntendo University, 2-1-1 Hongou, Bunkyo, Tokyo, Japan
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Neuromodulation for Ventricular Tachycardia and Atrial Fibrillation: A Clinical Scenario-Based Review. JACC Clin Electrophysiol 2019; 5:881-896. [PMID: 31439288 DOI: 10.1016/j.jacep.2019.06.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/30/2019] [Accepted: 06/04/2019] [Indexed: 12/17/2022]
Abstract
Autonomic dysregulation in cardiovascular disease plays a major role in the pathogenesis of arrhythmias. Cardiac neural control relies on complex feedback loops consisting of efferent and afferent limbs, which carry sympathetic and parasympathetic signals from the brain to the heart and sensory signals from the heart to the brain. Cardiac disease leads to neural remodeling and sympathovagal imbalances with arrhythmogenic effects. Preclinical studies of modulation at central and peripheral levels of the cardiac autonomic nervous system have yielded promising results, leading to early stage clinical studies of these techniques in atrial fibrillation and refractory ventricular arrhythmias, particularly in patients with inherited primary arrhythmia syndromes and structural heart disease. However, significant knowledge gaps in basic cardiac neurophysiology limit the success of these neuromodulatory therapies. This review discusses the recent advances in neuromodulation for cardiac arrhythmia management, with a clinical scenario-based approach aimed at bringing neurocardiology closer to the realm of the clinical electrophysiologist.
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10
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AlKalbani A, AlRawahi N. Management of monomorphic ventricular tachycardia electrical storm in structural heart disease. J Saudi Heart Assoc 2019; 31:135-144. [PMID: 31198398 PMCID: PMC6556825 DOI: 10.1016/j.jsha.2019.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/17/2019] [Accepted: 05/03/2019] [Indexed: 02/08/2023] Open
Abstract
Electrical storm (ES) is a life-threatening condition that is defined by three or more episodes of sustained ventricular tachycardia (VT), ventricular fibrillation (VF), or appropriate shocks from an implantable cardioverter defibrillator (ICD) within 24 hours. The most common form of ES is monomorphic VT. It carries poor outcome despite all available intervention therapies. The therapies include rapid recognition of the condition, treatment of the reversible causes, ICD-reprogramming, antiarrhythmic drugs, sedation, and catheter ablation (CA). The first line antiarrhythmic drugs are amiodarone and β-blockers with superiority of propranolol over the others. The long-term use of the antiarrhythmic drugs is limited due to their adverse effects and drug-related proarrhythmic effect. The basic mechanism of monomorphic VT is re-entry pathway which can be targeted by CA. CA should be considered in drug refractory ES and patients should be referred in early course of disease. There are reported studies which showed the superiority of CA over the medical treatment in reducing the arrythmia burden and ICD appropriate shock. The survival benefit has been reported after successful ablation of ES in case series but to date no randomized control trial shows mortality benefit.
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11
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Weinstein AL, Gerstein NS, Santos JI, Schulman PM. Epinephrine-induced electrical storm after aortic surgery. Saudi J Anaesth 2019; 13:359-361. [PMID: 31572083 PMCID: PMC6753754 DOI: 10.4103/sja.sja_745_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Electrical storm (ES) is a potentially lethal syndrome defined as three or more sustained episodes of ventricular tachycardia or ventricular fibrillation within 24 h. There are multiple inciting factors for ES, one of which involves excess catecholamine (endogenous and exogenous) effects. Exogenous catecholamines used for hemodynamic support can paradoxically engender or exacerbate an underling arrhythmia leading to ES. We report on an 63-year-old man who presented for repair of an ascending aortic dissection. After cardiopulmonary bypass separation assisted with high-dose epinephrine, ES developed requiring over 40 defibrillatory shocks. The epinephrine infusion was held and within 5 min, the ES self-terminated. ES in the context of cardiovascular surgery with the use of epinephrine for hemodynamic support has not be previously reported. Clinicians need to be cognizant of the seemingly paradoxical effect of epinephrine to induce ES. Initial ES treatment involves acute stabilization (treating or removing exacerbating factors (i.e., excess catecholamines)).
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Affiliation(s)
- Adam L Weinstein
- Department of Anesthesiology, UW School of Medicine and Public Health, Madison, WI, USA
| | - Neal S Gerstein
- Department of Anesthesiology and Critical Care Medicine, Albuquerque, NM, USA
| | - Josh I Santos
- Department of Anesthesiology and Critical Care Medicine, Albuquerque, NM, USA
| | - Peter M Schulman
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR, USA
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12
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Insufficient left ventricular unloading after extracorporeal membrane oxygenation : A case-series observational study. Herz 2018; 45:186-191. [PMID: 29777285 DOI: 10.1007/s00059-018-4711-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/23/2018] [Accepted: 04/23/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is a method widely used to support circulation in patients with fulminant myocarditis (FM). However, a common complication associated with ECMO is left ventricular (LV) overload. METHODS This case series observed the effects of intra-aortic balloon pump (IABP) and beta-blockers for the treatment of LV overload after ECMO. The cases of eight patients with FM who underwent ECMO from September 2009 to July 2016 were reviewed. RESULTS Six of the eight patients survived. After ECMO treatment, insufficient LV unloading occurred in six patients. Among these six patients, three experienced electrical storm but spontaneous circulation returned after interventions with beta-blockers and IABP. The survivors demonstrated full recovery of cardiac function. CONCLUSION Beta-blockers may prevent the occurrence of electrical storm, and IABP is feasible for the treatment of LV overload after ECMO application.
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Mattsson G, Magnusson P. Electrical storm in the inflamed heart: ventricular tachycardia due to myocarditis. Clin Case Rep 2017; 5:1327-1332. [PMID: 28781852 PMCID: PMC5538064 DOI: 10.1002/ccr3.1071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 06/05/2017] [Accepted: 06/13/2017] [Indexed: 12/05/2022] Open
Abstract
Electrical storm during the acute inflammatory phase caused by myocarditis may be resistant to antiarrhythmic therapy. Cardiac imaging including magnetic resonance tomography, positron emission tomography, and endomyocardial biopsy are crucial to guide potential therapeutic options. Optimal management involves a multidisciplinary approach, including expertise beyond cardiology.
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Affiliation(s)
- Gustav Mattsson
- Centre for Research and DevelopmentUppsala University/Region GävleborgGävleSE‐ 801 87Sweden
| | - Peter Magnusson
- Centre for Research and DevelopmentUppsala University/Region GävleborgGävleSE‐ 801 87Sweden
- Cardiology Research UnitDepartment of MedicineKarolinska InstitutetStockholmSE‐171 76Sweden
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Margos P, Margos N, Mokadem N, Patsiotis I, Kranidis A. Ranolazine: safe and effective in a patient with hypertensive cardiomyopathy and multiple episodes of electrical storm. Clin Case Rep 2017; 5:1170-1175. [PMID: 28680620 PMCID: PMC5494397 DOI: 10.1002/ccr3.1019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/11/2017] [Accepted: 04/09/2017] [Indexed: 12/19/2022] Open
Abstract
Among implantable cardioverter-defibrillator (ICD) recipients, there are patients with recurrent episodes of electrical storm (ES), retractable to the optimal antiarrhythmic drug therapy or invasive ablation procedures. A relatively novel anti-ischemic drug with also antiarrhythmic properties, ranolazine, may effectively suppress ventricular arrhythmias in such patients for a long period of time.
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Affiliation(s)
- Panagiotis Margos
- 1 Cardiology DepartmentGeneral Hospital of Nikea‐Piraeus “Agios Panteleimon”Nikea‐PiraeusGreece
| | - Nikolaos Margos
- 1 Cardiology DepartmentGeneral Hospital of Nikea‐Piraeus “Agios Panteleimon”Nikea‐PiraeusGreece
| | - Nadiya Mokadem
- 1 Cardiology DepartmentGeneral Hospital of Nikea‐Piraeus “Agios Panteleimon”Nikea‐PiraeusGreece
| | - Ilias Patsiotis
- 1 Cardiology DepartmentGeneral Hospital of Nikea‐Piraeus “Agios Panteleimon”Nikea‐PiraeusGreece
| | - Athanasios Kranidis
- 1 Cardiology DepartmentGeneral Hospital of Nikea‐Piraeus “Agios Panteleimon”Nikea‐PiraeusGreece
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Li LI, Zhou YL, Zhang XJ, Wang HT. Successful treatment of cardiac electrical storm in dilated cardiomyopathy using esmolol: A case report. Exp Ther Med 2016; 12:107-110. [PMID: 27347024 PMCID: PMC4906816 DOI: 10.3892/etm.2016.3281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 03/18/2016] [Indexed: 01/03/2023] Open
Abstract
The present study reports a case of electrical storm occurring in a 43-year-old woman with dilated cardiomyopathy. The patient suffered from a cardiac electrical storm, with 98 episodes of ventricular tachycardia rapidly degenerating to ventricular fibrillation in hospital. The patient was converted with a total of 120 defibrillations. Recurrent ventricular tachycardia/fibrillation was initiated by premature ventricular beats. The patient did not respond to the use of amiodaronum. However, the administration of esmolol stabilized the patient's heart rhythm. A moderate dose of the β-blocker esmolol, administered as an 0.5-mg intravenous bolus injection followed by an infusion at a rate of 0.15 mg/kg/min, inhibited the recurrence of ventricular fibrillation and normalized the electrocardiographic pattern. The results suggest that esmolol may be able to improve the survival rate of patients with electrical storm in dilated cardiomyopathy and should be considered as a primary therapy in the management of cardiac electrical storms.
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Affiliation(s)
- L I Li
- Department of Cardiology, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
| | - Yuan-Li Zhou
- Department of Health, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
| | - Xue-Jing Zhang
- Department of Cardiology, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
| | - Hua-Ting Wang
- Department of Cardiology, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
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