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Sympathetic Blockade for Patients Experiencing "Electrical Storm"

The term "electrical storm" (ES) is used to describe a cluster of repeated episodes of ventricular fibrillation requiring multiple cardioversions. Most patients who experience ES, particularly in association with ischemia or MI, die within minutes. To test whether sympathetic blockade might be effective for treating ES, investigators prospectively examined 49 patients who experienced ES between 3 days and 3 months after MI.

Within 1 hour of discontinuation of antiarrhythmic agents that were used during the initial cardiac arrest code (according to Advanced Cardiac Life Support [ACLS] guidelines), 27 patients received sympathetic blockade; the remaining 22 continued to receive conventional ACLS-guided treatment. Among those treated with sympathetic blockade, 6 underwent left stellate ganglionic blockade, 7 received esmolol, and 14 received popranolol.

The 1-week mortality rate was significantly higher among those who received ACLS-guided treatment alone than among those treated with sympathetic blockade (82 percent vs. 22 percent). Among all patients who survived the initial ES event and were discharged from the hospital (total, 22), 1-year survival was excellent (86 percent). The overall survival rate at 1 year was significantly higher among patients treated with sympathetic blockade (18 of 27, 67 percent) than among those treated conventionally (1 of 22, 5 percent).

Comment: Despite the obvious design limitations of this single-center study, the dramatically higher survival rate among patients experiencing an electrical storm who received sympathetic blockade versus those who received conventional therapy is too large to ignore. These findings ought to be taken seriously by physicians who are involved in the care of such patients. Further studies should address unanswered questions, including which sympathetic-blockade approach is optimal and whether some subgroups respond differently to sympathetic blockade.

— H Calkins

Published in Journal Watch Cardiology November 9, 2000

Citation(s):

Nademanee K et al. Treating electrical storm: Sympathetic blockade versus advanced cardiac life support-guided therapy. Circulation 2000 Aug 15 102 742-747.

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