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ELECTRICAL STORM: CLINICAL PREDICTORS AND RISK FACTORS IN PATIENTS WITH IMPLANTED CARDIOVERTERS-DEFIBRILLATORS

Abstract

To develop methods of early diagnostics and to reveal risk factors of ventricular arrhythmias (VA) and electrical storm (ES) in patients with chronic heart failure (CHF), 459 patients (men: 87%) aged 64.07±12.11 years were included into the study. The study subjects were assessed and treated in 1999 through 2014 in four general hospitals in St. Petersburg, Russia. For prevention of sudden cardiac death (SCD) and therapy of CHF, 125 single-chamber cardioverters-defibrillators (ICD) (27.2%), 167 dual-chamber ICD (36.4%), and 167 cardiac resynchronization therapy defibrillators (CRT D) (36.4%) were implanted. Implantation of ICD or CRT D was made for primary prevention of SCD in 68.7% of cases. The study subject follow-up period lasted for 6.2±2.8 years. The study subjects were distributed into two following groups: Group I (n=38) included patients with electric storm and Group II (n=421), patients without electric storm. The annual incidence of ICD shocks was 319 ones, without significant difference in patients with and without ES. In 13.2% of patients, ES occurred within the first year after implantation of ICD or CRT D. The following most significant risk factors of ES were revealed: QRS complex width, mean heart rate (HR), left ventricular (LV) ejection fraction (EF), end-diastolic diameter (EDD) of LV, end-systolic diameter (ESD) of LV, LV hypertrophy, extent of mitral insufficiency, LV diastolic dysfunction, number of episodes of antitachycarditic pacing, number of ICD shocks per year, and changes in CHF functional class. In 1999 through 2014, 22.9% of patients with ICD or CRT D deceased (15% of patients due to CHF deterioration, 5.2% of patients due to ES., and 2.7% of patients due to extracardiac causes). Mortality of patients with CHF progression was significantly higher than in subjects with stable or improving CHF (p<0.005). The survival analysis showed no significant difference between the study groups during first two years of follow-up. After the third year of follow-up, a significantly increased mortality of patients with ES was observed; after the fifth year, survival of patients with ES decreased to 30%, as opposed to 99% reported in the patient group without ES.

About the Authors

A. M. Osadchiy
ФГБУ «Федеральный медицинский исследовательский центр им. В.А.Алмазова» Минздравсоцразвития РФ; СПб ГБУЗ ГБ № 40; ФГБУ «НМХЦ им. Н.И. Пирогова» СПКК Минздравсоцразвития РФ, Санкт-Петербург
Russian Federation


V. K. Lebedeva
ФГБУ «Федеральный медицинский исследовательский центр им. В.А.Алмазова» Минздравсоцразвития РФ; СПб ГБУЗ ГБ № 40; ФГБУ «НМХЦ им. Н.И. Пирогова» СПКК Минздравсоцразвития РФ, Санкт-Петербург
Russian Federation


E. A. Kurnikova
ФГБУ «Федеральный медицинский исследовательский центр им. В.А.Алмазова» Минздравсоцразвития РФ; СПб ГБУЗ ГБ № 40; ФГБУ «НМХЦ им. Н.И. Пирогова» СПКК Минздравсоцразвития РФ, Санкт-Петербург
Russian Federation


A. V. Kamenev
ФГБУ «Федеральный медицинский исследовательский центр им. В.А.Алмазова» Минздравсоцразвития РФ; СПб ГБУЗ ГБ № 40; ФГБУ «НМХЦ им. Н.И. Пирогова» СПКК Минздравсоцразвития РФ, Санкт-Петербург
Russian Federation


S. G. Shcherbak
ФГБУ «Федеральный медицинский исследовательский центр им. В.А.Алмазова» Минздравсоцразвития РФ; СПб ГБУЗ ГБ № 40; ФГБУ «НМХЦ им. Н.И. Пирогова» СПКК Минздравсоцразвития РФ, Санкт-Петербург
Russian Federation


D. S. Lebedev
ФГБУ «Федеральный медицинский исследовательский центр им. В.А.Алмазова» Минздравсоцразвития РФ; СПб ГБУЗ ГБ № 40; ФГБУ «НМХЦ им. Н.И. Пирогова» СПКК Минздравсоцразвития РФ, Санкт-Петербург
Russian Federation


References

1. Бокерия Л.А., Гудкова Р.Г. Результаты научных исследований по проблеме сердечно-сосудистой хирургии в 2010 году // Грудная и сердечно-сосудистая хирургия - 2011. - № 3. - С. 63-71.

2. Заболеваемость населения России в 2007 году. Статистические материалы. Москва, 2008.

3. Клинические рекомендации Всероссийского научного общества специалистов по клинической электрофизиологии, аритмологии и кардиостимуляции по проведению клинических электрофизиологических исследований, катетерной аблации и имплантации антиаритмических устройств. М.: Новая редакция, 2011. - 518 с.

4. Streitner F., Kuschyk J., Veltmann C. et al. Predictors of electrical storm recurrences in patients with implantable cardioverter-defibrillators. // Europace. - 2011. № 13. - P. 668-674.

5. Aliot E.M., Stevenson W.G., Almendral-Garrote J.M. et al. EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA) // Heart Rhythm 2009; 6(6): 886-933.

6. Zipes D.P., Roberts D. for the Pacemaker-Cardioverter-Defibrillator Investigators. Results of the international study of the implantable pacemaker cardioverter-defibrillator: a comparison of epicardial and endocardial lead systems // Circulation 1995; 92: 59-65.

7. Eifling M., Razavi M., Massumi A. The Evaluation and Management of Electrical Storm. // Texas Heart Institute Journal. - 2011. - Vol. 38. № 2. - P. 111-121.

8. Guerra F., Shkoza M., Scappini L. et al. Role of electrical storm as a mortality and morbidity risk factor and its clinical predictors: a meta-analysis // Europace (2014) 16, 347-353.

9. Национальные рекомендации ВНОК И ОССН по диагностике и лечению ХСН (третий пересмотр) // Сердечная Недостаточность. - 2010. - Т.11, № 1(57). -С. 3-62.

10. Осадчий А.М., Качанов И.Н., Шлойдо Е.А. и др. Выбор хирургического доступа для имплантации левожелудочкового электрода по данным продленной коронароангиографии. // Вестник Хирургии им. И.И. Грекова. - 2011. Том 170. № 3. С 11-16.


Review

For citations:


Osadchiy A.M., Lebedeva V.K., Kurnikova E.A., Kamenev A.V., Shcherbak S.G., Lebedev D.S. ELECTRICAL STORM: CLINICAL PREDICTORS AND RISK FACTORS IN PATIENTS WITH IMPLANTED CARDIOVERTERS-DEFIBRILLATORS. Journal of Arrhythmology. 2014;(78):31-35. (In Russ.)

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ISSN 1561-8641 (Print)
ISSN 2658-7327 (Online)