CLINICAL RESEARCH
Risk factors and prognostic role of an electrical storm in patients after myocardial infarction with an implanted ICD for secondary prevention
 
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Submission date: 2015-10-07
Final revision date: 2016-03-25
Acceptance date: 2016-03-26
Online publication date: 2016-05-05
Publication date: 2018-04-13
 
Arch Med Sci 2018;14(3):500–509
 
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ABSTRACT
Introduction:
The aim of our study was to determine the risk factors for electrical storm (ES) and to assess the impact of ES on the long-term prognosis in patients after myocardial infarction (MI) with an implantable cardioverter-defibrillator (ICD) for secondary prevention of sudden cardiac death (SCD).

Material and methods:
We retrospectively analyzed 416 patients with coronary artery disease after MI who had an implanted ICD for secondary prevention of SCD. Fifty (12%) patients had one or more incidents of an electrical storm – the ES (+) group. We matched the reference group of 47 patients from 366 ES (–) patients.

Results:
We analyzed 3,408 episodes of ventricular arrhythmias: 3,148 ventricular tachyarrhythmic episodes in the ES (+) group (including 187 episodes of ES) and 260 in the ES (–) group. Multivariate logistic regression showed that inferior wall MI (RR = 3.98, 95% CI: 1.52–10.41) and the absence of coronary revascularization (RR = 2.92, 95% CI: 1.18–7.21) were independent predictors of ES (p = 0.0014). During 6-year observation of 97 patients, there were 39 (40%) deaths: 25 (50%) subjects in the ES (+) group and 14 (30%) in the ES (–) group (p = 0.036). Independent predictors of death were: the occurrence of ES (HR = 1.93), older age (HR = 1.06), and lower left ventricular ejection fraction (HR = 0.95) (for all p < 0.001).

Conclusions:
Electrical storm in patients after MI with ICD for secondary prevention is a relatively common phenomenon and has a negative prognostic significance. Myocardial infarction of the inferior wall and the absence of coronary revascularization are predisposing factors for the occurrence of an ES.

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