In-Hospital Electrical Storm in Acute Myocardial Infarction ― Clinical Background and Mechanism of the Electrical Instability ―

Yoshinori Kobayashi, Kaoru Tanno, Akira Ueno, Seiji Fukamizu, Hiroshige Murata, Norikazu Watanabe, Takeshi Sasaki, Takeshi Yamamoto, Morimasa Takayama, Ken Nagao
2018 Circulation Journal  
Recurrent ventricular tachycardia (VT) and fibrillation (VF), the so-called "electrical storm" (ES) occurs at various stages of acute myocardial infarction (AMI), but its incidence, background, and short-term prognosis remain unclear. Methods and Results: A retrospective observational study was performed using the registry database of the Tokyo CCU Network. The individual data of 6,003 patients with AMI during 2011-2012 was corrected. ES was defined as more than 3 episodes of sustained VT/VF
more » ... sustained VT/VF during a 24-h period as first documented after hospitalization. ES occurred in 55 patients after admission (0.9%). The ES(+) group had more severe heart failure (Killip class >III), more extensive MI (peak-CK), greater inflammatory reaction (CRP), history of diabetes, and more frequent application of hemodialysis as compared with the ES(−) group (n=5,865). When the ES patients were divided into Early-ES (n=37: ES occurred ≤48 h after the onset of MI) and Late-ES (n=15 >48 h after onset of MI) groups, logistic regression analysis revealed that Early-ES was associated with severity of MI, whereas Late-ES was related to systemic disorders, including inflammation, renal dysfunction, or diabetes. Late-ES was an independent predictor of in-hospital death. Conclusions: In-hospital ES was a rare clinical manifestation of AMI. The features and background of the ES varied as time elapsed after admission for MI.
doi:10.1253/circj.cj-18-0785 fatcat:23u2gskq2bbtbfit4n2n3im6ta