Predictors of Electrical Storm in Patients With Idiopathic Dilated Cardiomyopathy – How to Stratify the Risk of Electrical Storm –

Masateru Takigawa; Takashi Noda; Takashi Kurita; Naohiko Aihara; Yuko Yamada; Hideo Okamura; Kazuhiro Satomi; Kazuhiro Suyama; Wataru Shimizu; Shiro Kamakura

doi:10.1253/circj.CJ-10-0092

Arrhythmia/Electrophysiology

Predictors of Electrical Storm in Patients With Idiopathic Dilated Cardiomyopathy

– How to Stratify the Risk of Electrical Storm –

Masateru Takigawa, Takashi Noda, Takashi Kurita, Naohiko Aihara, Yuko Yamada, Hideo Okamura, Kazuhiro Satomi, Kazuhiro Suyama, Wataru Shimizu, Shiro Kamakura

Author information

Masateru Takigawa
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center
Takashi Noda
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center
Takashi Kurita
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center
Naohiko Aihara
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center
Yuko Yamada
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center
Hideo Okamura
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center
Kazuhiro Satomi
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center
Kazuhiro Suyama
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center
Wataru Shimizu
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center
Shiro Kamakura
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center

Keywords: Dilated cardiomyopathy, Electrical storm, Implantable cardioverter defibrillator, Signal averaged electrocardiogram, Ventricular tachyarrhythmias

JOURNAL FREE ACCESS

2010 Volume 74 Issue 9 Pages 1822-1829

DOI https://doi.org/10.1253/circj.CJ-10-0092

View "Advance Publication" version (July 29, 2010).

Details

Abstract

Background: Electrical storm (ES) is a serious problem in patients with an implantable cardioverter defibrillator (ICD). However, insufficient reports have indicated the predictors of ES in ICD patients with idiopathic dilated cardiomyopathy (DCM). The purpose of this study was to clarify the predictors of ES for risk stratification in DCM patients with an ICD. Methods and Results: Of 446 ICD patients, 53 DCM patients were included in this study. During a mean follow-up of 55±36 months, ES (≥3 times appropriate ICD therapy within 24 h) occurred in 18/53 (34%) patients. According to multivariate Cox proportional hazard regression analysis, a duration of the terminal low amplitude signals of <40 μV (LAS40) (HR 1.4/10 ms increase, 95% confidence interval (CI) 1.1-2.1; P=0.0049) or root mean square voltage of the last 40 ms of the QRS complex (RMS40) (HR 0.88/1 μV, 95%CI 0.77-0.96; P=0.001) on the signal averaged electrocardiogram, and a history of atrial fibrillation (AF) before ICD implantation (HR 2.3, 95%CI 1.2-5.0; P=0.013) were independently associated with an increased risk of ES. Conclusions: Our data indicated that a longer LAS40, lower RMS40 and history of AF before ICD implantation could strongly predict ES, and the combination of those parameters could effectively stratify the risk of ES in DCM patients. (Circ J 2010; 74: 1822 - 1829)

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