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European Heart Journal Advance Access originally published online on October 18, 2006
European Heart Journal 2006 27(24):3027-3032; doi:10.1093/eurheartj/ehl276
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Electrical storm in patients with an implantable defibrillator: incidence, features, and preventive therapy: insights from a randomized trial

Stefan H. Hohnloser1,*, Hussein R. Al-Khalidi2, Craig M. Pratt3, Jose M. Brum2, Daljit S. Tatla2, Patrick Tchou4, Paul Dorian5 on behalf of the SHock Inhibition Evaluation with AzimiLiDe (SHIELD) Investigators

1 Division of Electrophysiology, Department of Cardiology, J.W. Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
2 Procter & Gamble Pharmaceuticals, Health Care Research Center, Cincinnati, OH, USA
3 The Methodist DeBakey Heart Center, Houston, TX, USA
4 Cleveland Clinic Foundation, Cardiology Department, Cleveland, OH, USA
5 Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada

Received 7 March 2006; revised 25 July 2006; accepted 11 September 2006; online publish-ahead-of-print 18 October 2006.

* Corresponding author. Tel: +49 69 6301 7404; fax: +49 69 6301 7017. E-mail address: hohnloser{at}em.uni-frankfurt.de

See page 2921 for the editorial comment on this article (doi:10.1093/eurheartj/ehl396)

Aims The purpose of this study was to assess the incidence, features, and clinical sequelae of ‘electrical storm’ (ES).

Methods and results This study is a prospectively designed secondary analysis of SHIELD; a randomized trial of azimilide for suppression of ventricular tachycardia/fibrillation (VT/VF) leading to implanted cardioverter defibrillator (ICD) therapies. Systematic and rigorous follow-up and blinded adjudication of ICD therapy allowed identification of all ESs (≥3 separate VT/VF episodes leading to ICD therapies within 24 h). Of 633 ICD recipients, 148 (23%) experienced at least one ES over 1-year follow-up. No clinical predictors of ES were identified. Frequent VT episodes accounted for 91% of all ESs, with the remaining being VF alone or both VT plus VF. ES led to a 3.1-fold increase in arrhythmia-related hospitalization (95% CI 2.3–4.3; P<0.0001) compared with patients with isolated VT/VF, and to a 10.2-fold increase (95% CI 6.4–16.3; P<0.0001) compared with patients without VT/VF. Compared with placebo, azimilide (75 and 125 mg/day) reduced the risk of recurrent ES by 37% (HR=0.63, 95% CI 0.35–1.11, P=0.11) and 55% (HR=0.45, 95% CI 0.23–0.87, P=0.018), respectively. However, the reduction in time-to-first ES did not reach statistical significance by both doses (75 and 125 mg) of azimilide (HR=0.82, 95% CI 0.56–1.19, P=0.29 and HR=0.69, 95% CI 0.46–1.04, P=0.07), respectively.

Conclusion ES is common and unpredictable in ICD recipients and it is a strong predictor of hospitalization.

Key Words: Azimilide dihydrochloride • Implantable cardioverter defibrillator • Antiarrhythmic therapy • Ventricular tachycardia storms


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