The role of antiarrhythmic drugs and stellate ganglion block in the acute management of electrical storm.

IF 1.7 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal Supplements Pub Date : 2025-02-19 eCollection Date: 2025-02-01 DOI:10.1093/eurheartjsupp/suae084
Veronica Dusi, Filippo Angelini, Carol Gravinese, Simone Frea, Gaetano Maria De Ferrari
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Abstract

Electrical storm (ES) is a life-threatening condition characterized by at least three separate episodes of ventricular arrhythmia (VAs) over 24 h, each one requiring intervention. Early recognition and prompt treatment are crucial to improving outcomes. In addition to identifying and correcting potential reversible causes, performing acute cardiac life support if required, and interrogating/reprogramming the implantable cardioverter defibrillator in present, the acute management of ES (within 12-24 h upon presentation) nowadays mostly relies on antiarrhythmic drugs and percutaneous left ganglion sympathetic block (PLSGB), that will be the focus of the present review. The choice of the drug should consider several factors, including the aetiology and mechanism of VAs, the underlying cardiac function, and the potential risk of adverse events. Intravenous amiodarone, the most used and recommended drug in the setting of high burden VAs and structural heart disorders, mostly exerts dose and rate infusion dependent antiadrenergic effects in the first hours, and may lead to severe hypotension. PLSGB has an excellent safety-efficacy profile and can be easily performed by trained cardiologists at bedside.

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电风暴(ES)是一种危及生命的疾病,其特征是在 24 小时内至少有三次独立的室性心律失常(VAs)发作,每次发作都需要干预。早期识别和及时治疗对改善预后至关重要。除了识别和纠正潜在的可逆性病因、必要时实施急性心脏生命支持以及对植入式心律转复除颤器进行询问/重新编程外,目前 ES 的急性治疗(发病后 12-24 小时内)大多依赖于抗心律失常药物和经皮左侧神经节交感神经阻滞(PLSGB),这将是本综述的重点。药物的选择应考虑多个因素,包括 VAs 的病因和机制、基础心脏功能以及不良事件的潜在风险。静脉注射胺碘酮是高负担 VAs 和结构性心脏疾病情况下最常用和最推荐的药物,其抗肾上腺素能作用大多在最初几小时内发挥,且依赖于剂量和输注速度,并可能导致严重低血压。PLSGB 具有极佳的安全性和有效性,训练有素的心脏病专家可在床旁轻松实施。
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来源期刊
European Heart Journal Supplements
European Heart Journal Supplements 医学-心血管系统
CiteScore
3.00
自引率
0.00%
发文量
575
审稿时长
12 months
期刊介绍: The European Heart Journal Supplements (EHJs) is a long standing member of the ESC Journal Family that serves as a publication medium for supplemental issues of the flagship European Heart Journal. Traditionally EHJs published a broad range of articles from symposia to special issues on specific topics of interest. The Editor-in-Chief, Professor Roberto Ferrari, together with his team of eminent Associate Editors: Professor Francisco Fernández-Avilés, Professors Jeroen Bax, Michael Böhm, Frank Ruschitzka, and Thomas Lüscher from the European Heart Journal, has implemented a change of focus for the journal. This entirely refreshed version of the European Heart Journal Supplements now bears the subtitle the Heart of the Matter to give recognition to the focus the journal now has. The EHJs – the Heart of the Matter intends to offer a dedicated, scientific space for the ESC, Institutions, National and Affiliate Societies, Associations, Working Groups and Councils to disseminate their important successes globally.
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