Abstract
Ventricular arrhythmias encompass a spectrum from isolated premature ventricular complexes to ventricular fibrillation, manifest by clinical syndromes ranging from palpitations to sudden cardiac death. Episodes may be isolated or recurrent (electrical storm). Myocardial ischemia, underlying structural heat disease, and channelopathies are the most common etiologies of ventricular arrhythmias. The management of life-threatening sustained ventricular arrhythmias—including monomorphic and polymorphic ventricular tachycardia (VT) and ventricular fibrillation (VF)—is an important skill in critical care medicine. In the setting of pulseless VT or VF, guideline-directed ACLS—including defibrillation—should be implemented immediately. Diagnostic evaluation, including the selective use of blood tests, echocardiography, and coronary angiography, should be initiated simultaneous to treatment. Therapies should be tailored to the clinical situation, and may include electrolyte repletion, beta-adrenergic blockade, and the use of antiarrhythmic agents (particularly amiodarone), mechanical circulatory support, and radiofrequency catheter ablation.
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References
Moss AJ, Schuger C, Beck CA, Brown MW, Cannom DS, Daubert JP, et al. Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med. 2012;367:2275–83.
Nademanee K, Taylor R, Bailey WE, Rieders DE, Kosar EM. Treating electrical storm: sympathetic blockade versus advanced cardiac life support-guided therapy. Circulation. 2000;102:742–7.
Chatzidou S, Kontogiannis C, Tsilimigras DI, Georgiopoulos G, Kosmopoulos M, Papadopoulou E, et al. Propranolol versus metoprolol for treatment of electrical storm in patients with implantable cardioverter-defibrillator. J Am Coll Cardiol. 2018;71:1897–906.
Brodine WN, Tung RT, Lee JK, Hockstad ES, Moss AJ, Zareba W, et al. Effects of beta-blockers on implantable cardioverter defibrillator therapy and survival in the patients with ischemic cardiomyopathy (from the multicenter automatic defibrillator implantation trial-ii). Am J Cardiol. 2005;96:691–5.
Connolly SJ, Dorian P, Roberts RS, Gent M, Bailin S, Fain ES, et al. Comparison of beta-blockers, amiodarone plus beta-blockers, or sotalol for prevention of shocks from implantable cardioverter defibrillators: the optic study: a randomized trial. JAMA. 2006;295:165–71.
Desouza IS, Martindale JL, Sinert R. Antidysrhythmic drug therapy for the termination of stable, monomorphic ventricular tachycardia: a systematic review. Emerg Med J. 2013;68:392–7.
Levine JH, Massumi A, Scheinman MM, Winkle RA, Platia EV, Chilson DA, et al. Intravenous amiodarone for recurrent sustained hypotensive ventricular tachyarrhythmias. Intravenous Amiodarone Multicenter Trial Group. J Am Coll Cardiol. 1996;27(1):67–75.
Hohnloser SH, Klingenheben T, Singh BN. Amiodarone-associated proarrhythmic effects. A review with special reference to torsade de pointes tachycardia. Ann Intern Med. 1994;121(7):529–35.
Dorian P, Cass D, Schwartz B, Cooper R, Gelaznikas R, Barr A. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med. 2002;346:884–90.
Fotopoulos GD, Mason MJ, Walker S, Jepson NS, Patel DJ, Mitchell AG, et al. Stabilisation of medically refractory ventricular arrhythmia by intra-aortic balloon counterpulsation. Heart. 1999;82(1):96–100.
Tsai FC, Wang YC, Huang YK, Tseng CN, Wu MY, Chu JJ, et al. Extracorporeal life support to terminate refractory ventricular tachycardia. Crit Care Med. 2007;35:1673–6.
Calkins H, Epstein A, Packer D, Arria AM, Hummel J, Gilligan DM, Cooled RF Multi Center Investigators Group, et al. Catheter ablation of ventricular tachycardia in patients with structural heart disease using cooled radiofrequency energy: results of a prospective multicenter study. J Am Coll Cardiol. 2000;35:1905–14.
Carbucicchio C, Santamaria M, Trevisi N, Maccabelli G, Giraldi F, Fassini G, et al. Catheter ablation for the treatment of electrical storm in patients with implantable cardioverter-defibrillators: short- and long-term outcomes in a prospective single center study. Circulation. 2008;117:462–9.
Sapp JL, Wells GA, Parkash R, Stevenson WG, Blier L, Sarrazin JF, et al. Ventricular tachycardia ablation versus escalation of antiarrhythmic drugs. N Engl J Med. 2016;375:111–21.
Sacher F, Sobieszczyk P, Tedrow U, Eisenhauer AC, Field ME, Selwyn A, et al. Transcoronary ethanol ventricular tachycardia ablation in the modern electrophysiology era. Heart Rhythm. 2008;5:62–8.
Tokuda M, Sobieszczyk P, Eisenhauer AC, Kojodjojo P, Inada K, Koplan BA, et al. Transcoronary ethanol ablation for recurrent ventricular tachycardia after failed catheter ablation: an update. Circ Arrhythm Electrophysiol. 2011;4:889.
Baher A, Shah DJ, Valderrabano M. Coronary venous ethanol infusion for the treatment of refractory ventricular tachycardia. Heart Rhythm. 2012;9:1637–9.
Witt CM, Bolona L, Kinney MO, Moir C, Ackerman MJ, Kapa S, et al. Denervation of the extrinsic cardiac sympathetic nervous system as a treatment modality for arrhythmia. Europace. 2017;19:1075–83.
Vaseghi M, Gima J, Kanaan C, Ajijola O, Marmureanu A, Mahajan A, et al. Cardiac sympathetic denervation in patients with refractory ventricular arrhythmias or electrical storm: intermediate and long-term follow-up. Heart Rhythm. 2014;11:360.
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Tariq, S., Cooper, H.A. (2020). Ventricular Arrhythmias. In: Hyzy, R.C., McSparron, J. (eds) Evidence-Based Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-26710-0_17
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DOI: https://doi.org/10.1007/978-3-030-26710-0_17
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