Electric storm is a phenomenon that occurs relatively rarely in patients with implanted cardioverter-defibrillator (ICD) devices, but when it occurs - it is dangerous. In therapeutic management, the most important thing is prompt hospitalization, precise diagnosis of the causes of the electric storm and the correct selection of an effective method of treatment. Professional psychological support is also important. Only a comprehensive diagnostic and therapeutic measure can effectively help the patient, say doctors and patients. Read about the electric storm phenomenon.

What is an electrical storm in the heart?

- An electrical storm is at least three ventricular arrhythmias occurring within 24 hours or continuous ventricular tachycardia - says Michał Orczykowski, MD, PhD from the Laboratory of Electrophysiology of the Department of Heart Rhythm Disorders at the Institute of Cardiology in Warsaw. - The phenomenon began to be discussed more often, since patients began to implant cardioverter-defibrillators (ICD) on a larger scale. In centers with high reference, where patients from a large area of ​​the country reach, we deal with electric storms practically every week - adds Michał Orczykowski, MD, PhD.

Electric storm - what's going on in the heart?

- During an electrical storm, reentry arrhythmias, i.e. recurrent tachycardias, most often develop in the patient's heart. They can be compared to a motorboat that goes around an island in a lake. Electrical excitations oscillate in places of slow conduction around some anatomical barrier - for example a scar - says Michał Orczykowski, MD, PhD. - This is when ventricular tachycardia develops. Focal tachycardia is a rarer phenomenon - it is the kind where arrhythmias arise from only one point in the heart - explains Michał Orczykowski, MD, PhD.

An electrical storm in the heart can be life-threatening. In patients who have an implanted cardioverter defibrillator, the device first attempts to terminate the arrhythmia by rapid pacing. If this fails and the storm continues, electrical discharges occur. An ICD can effectively interrupt an electrical storm, but this is not the case 100% of the time.

- I have survived three electrical storms and only one of them ended in an interruptionarrhythmia with cardioverter-defibrillator discharge - says 27-year-old Marzena Osipińska, who was diagnosed with arrhythmogenic right ventricular cardiomyopathy three years ago. - The other two storms were characterized by tachycardia with a frequency so low that they had to be interrupted by doctors - cardioversion (defibrillation) and drug infusions - says Marzena Osipińska.

Causes of the electric storm

In patients who experience an electrical storm, doctors always check for any reversible causes. One of them is electrolyte disturbances, especially hypokalemia, i.e. low potassium levels. Potassium has an anti-arrhythmic effect, and electrical storms often occur in patients who have heart failure and are taking diuretics that lower potassium levels, which can lead to an electrical storm.

The second very common cause of an electric storm is ischemia. There may be progressive pathological changes in the coronary vessels causing myocardial ischemia. This is another potential cause of arrhythmias and electric storms.

Electric storms can also be caused by drug poisoning or fever infections. In this case, electrolyte and acid-base disturbances should be ruled out - it may turn out that after the correction of these disturbances, the arrhythmia will disappear.

Dealing with an electric storm

- A patient suffering from an electrical storm must be admitted to an intensive care unit. A series of tests must be done to exclude electrolyte disturbances, poisoning, ischemia - says Michał Orczykowski, MD, PhD. - Coronary angiography should be performed in every patient with suspected coronary arrhythmia. If we detect a significant narrowing of the coronary vessel and there are appropriate indications for it, we perform angioplasty, which often turns out to be an effective method of treatment. - adds Michał Orczykowski, MD, PhD. - However, it often happens that despite the reversal or equalization of all the above phenomena, and even revascularization, angioplasty, arrhythmia still occurs. Then ablation is the golden standard of conduct - says M. Orczykowski, MD, PhD.

Ablation to help patients with electrical storms

Ablation can effectively help patients with cardiac arrhythmias who have experienced electrical storms and extend the life of this group of patients. Often in patients who come to reference centers with an electric storm and for whom the causes of this life-threatening arrhythmia cannot be eliminated otherwise,ablation procedures are performed immediately after the consultation.

- 5 foci of arrhythmia have been eliminated by ablation. I have not experienced a storm since then. I have not had any ICD intervention for almost a year, so I am an example that ablation is really effective - says Kamil Nowok.

Patients in whom ablation gives the greatest chance of success are post-infarction patients or patients with advanced coronary artery disease. After the infarction, the area of ​​damage is marked with scars. There is a border zone between the scar and the he althy muscle. Often the source of the arrhythmia is in the area where part of the muscle has survived the infarction - alive, but part of the muscle is scarred. It is there that the foci of slow conduction arise and it is a significant source of arrhythmia.

In such cases, doctors perform an electroanatomical map of the heart. - We can see exactly where the scar is, where the he althy tissue is, where the sick tissue is and where the potentials are fragmented. These fragmented potentials must be removed - most often with radio frequency (RF) ablation. At the end of the procedure, we try to induce this arrhythmia. We use aggressive stimulation of the patient's ventricles and check if there is an arrhythmia. Currently, proposing ablation in a center experienced in treating an electric storm in patients for whom we have exhausted other therapeutic options is strongly recommended - this is the gold standard of treatment - says Michał Orczykowski, MD, PhD.

According to data collected in the Polish Electric Storm Register - RECOVERY, initiated by the Polish Society of Cardiology, under the supervision of prof. dr hab. n. med. Łukasz Szumowski, developed in cooperation with a dozen Polish centers, to which 300 patients were enrolled, in patients who had not been ablated to the basis of the arrhythmia, the prognosis was much worse.

Psychological support for patients

All patients who have experienced an electric storm are advised to seek psychological support. - Probably everyone who has experienced an electric storm long after it is afraid of a recurrence of arrhythmia, a feeling of helplessness and pain caused by cardioverter-defibrillator discharges - says Kamil Nowok. - After experiencing an electric storm and several ICD discharges, I was diagnosed with post-traumatic stress disorder. It was hard, but proper medication and psychotherapy helped a lot. I advise everyone not to reject professional help - in our case, psychological support can really improve the quality of life. I experienced 14 cardioverter-defibrillator discharges - sometimes I say I died 14 times and was born again 14 times. Therapyallows you to understand that the ICD brought a lot of stress with its discharges, but it effectively saved my life. Thanks to him, I am still here - says Kamil Nowok.

- After the electrical storms I was afraid to sleep, to walk - says Andrzej Gajda. - I was helped by a psychiatrist who, through his support, allowed me to re-arrange everything and look at some things from a different perspective. This is invaluable help - he adds.

- At the Institute of Cardiology in Warsaw, we have a permanent team of psychologists who are able to provide patients and their families with appropriate support. Professor Franciszek Walczak always told young doctors that treatment with words is very important - we all agree with it, so we try to support and, as far as possible, positively set our patients with implantable devices. We know that this is an equally important aspect of therapy as surgical or pharmacological treatment, so we strongly encourage patients to take advantage of the help of specialists who know the specific needs of this group of patients - says Dr. M. Orczykowski.

Important

Electric storm - patient stories

- In my case, an electric storm appeared unexpectedly during a Valentine's trip with my fiancée to the swimming pool. - says the 26-year-old Kamil Nowok, who was diagnosed with arrhythmogenic cardiomyopathy at the age of 21 - There was no warning signal, only strong heartbeats, a feeling of spasm and painful discharges of a cardioverter-defibrillator - several times in a row. I wasn't able to do anything myself. Fortunately, a doctor appeared nearby who intervened. - adds Kamil Nowok.

- I was struck by an electric storm in my sleep - says Andrzej Gajda, a 43-year-old who was diagnosed with Brugada syndrome, a hereditary arrhythmogenic disease. - Suddenly I woke up, I wanted to take a breath and couldn't. I was unable to control the arrhythmia - I even fell out of bed. The wife quickly called an ambulance. I only got help in the second center I was referred to - the reference center, where the doctors knew exactly what to do in the event of an electrical storm in a patient with an ICD.

Category:

Cardiology