Abstract
Ventricular tachycardia storm (VTS) is defined as a life-threatening syndrome of three or more separate episodes of ventricular tachycardia (VT) leading to implantable cardioverter defibrillator (ICD) therapy within 24 hours. Patients with VTS have poor outcomes and require immediate medical attention. ICD shocks have been shown to be associated with increased mortality in several studies. Optimal programming in minimization of ICD shocks may decrease mortality. Large controlled trials showed that long detection time and high heart rate detection threshold reduced ICD shock burden without an increase in syncope or death. As a fundamental therapy of ICD, antitachycardia pacing (ATP) can terminate most slow VT with a low risk of acceleration. For fast VT, burst pacing is more effective and less likely to result in acceleration than ramp pacing. One algorithm of optimal programming management during a VTS is presented in the review.
Highlights
Implantable cardioverter defibrillator (ICD) has revolutionized the preventive treatment of patients at risk for sudden cardiac death and has been widely used for these high-risk individuals[1,2,3]
A meta-analysis showed that ICD for secondary prevention, monomorphic ventricular tachycardia (VT) as triggering arrhythmia, lower ejection fraction and class I anti-arrhythmic drugs were associated with electrical storm’’ (ES), which could be used to define high risk populations for ES[10]
The results showed that a single 8-pulse burst of antitachycardia pacing (ATP) was successful in terminating fast VT (FVT) in 72% of episodes and resulted in a significant reduction in shocks with improved quality of life and low rates of VT acceleration and syncope (Fig. 3)
Summary
Implantable cardioverter defibrillator (ICD) has revolutionized the preventive treatment of patients at risk for sudden cardiac death and has been widely used for these high-risk individuals[1,2,3]. A meta-analysis showed that ICD for secondary prevention, monomorphic VT as triggering arrhythmia, lower ejection fraction and class I anti-arrhythmic drugs were associated with ES, which could be used to define high risk populations for ES[10]. The detection and treatment of ventricular arrhythmias by an ICD involves a series of sequential steps, each of which provides an opportunity to prevent unnecessary shocks (Fig. 1). These steps include heart rate detection, number of intervals to detect (NID), tachycardia detection, supraventricular tachycardia (SVT)-VT discrimination, VT confirmation, ATP, reconfirmation, and shock.
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