The point on the treatment of arrhythmic storm

Arrhythmic storm is a clinical emergency associated with high mortality, which requires multi-disciplinary management. Reprogramming of the implantable cardiac defibrillator (ICD) aimed at reducing shocks, adrenergic blockade using beta-blockers, sedation/anxiolysis, and blockade of the stellate gan...

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Veröffentlicht in:European heart journal supplements 2024-04, Vol.26 (Suppl 1), p.i44-i48
Hauptverfasser: Lazzari, Ludovico, Donzelli, Stefano, Tordini, Alessandra, Parise, Antonio, Pirozzi, Ciro, Di Meo, Federica, Marallo, Carmine, Pace, Vincenzo, Marini, Chiara, Carreras, Giovanni
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Sprache:eng
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Zusammenfassung:Arrhythmic storm is a clinical emergency associated with high mortality, which requires multi-disciplinary management. Reprogramming of the implantable cardiac defibrillator (ICD) aimed at reducing shocks, adrenergic blockade using beta-blockers, sedation/anxiolysis, and blockade of the stellate ganglion represent the first simple and effective manoeuvres, but further suppression of arrhythmias with antiarrhythmics is often required. A low-risk patient (e.g. monomorphic ventricular tachycardia, functioning ICD, and haemodynamically stable) should be managed with a beta-blocker (possibly non-selective) plus amiodarone, in addition to sedation with a benzodiazepine or dexmedetomidine; in patients at greater risk (high burden and haemodynamic instability), autonomic modulation with blockade of the stellate ganglion and the addition of a second antiarrhythmic (lidocaine) should be considered. In patients refractory to these measures, with advanced heart failure, general anaesthesia with intubation and the establishment of a haemodynamic circulatory support should be considered. Ablation, performed early, appears to be superior in terms of mortality and reduction of future shocks compared with titration of antiarrhythmics.
ISSN:1520-765X
1554-2815
DOI:10.1093/eurheartjsupp/suae016