Successful treatment of cardiac electrical storm in dilated cardiomyopathy using esmolol: A case report

Li,Li; Zhou,Yuan‑Li; Zhang,Xue‑Jing; Wang,Hua‑Ting

doi:10.3892/etm.2016.3281

Successful treatment of cardiac electrical storm in dilated cardiomyopathy using esmolol: A case report

Authors:
- Li Li
- Yuan‑Li Zhou
- Xue‑Jing Zhang
- Hua‑Ting Wang
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Affiliations: Department of Cardiology, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China, Department of Health, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
Published online on: April 20, 2016 https://doi.org/10.3892/etm.2016.3281
Pages: 107-110
Copyright: © Li et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The present study reports a case of electrical storm occurring in a 43‑year‑old woman with dilated cardiomyopathy. The patient suffered from a cardiac electrical storm, with 98 episodes of ventricular tachycardia rapidly degenerating to ventricular fibrillation in hospital. The patient was converted with a total of 120 defibrillations. Recurrent ventricular tachycardia/fibrillation was initiated by premature ventricular beats. The patient did not respond to the use of amiodaronum. However, the administration of esmolol stabilized the patient's heart rhythm. A moderate dose of the β‑blocker esmolol, administered as an 0.5‑mg intravenous bolus injection followed by an infusion at a rate of 0.15 mg/kg/min, inhibited the recurrence of ventricular fibrillation and normalized the electrocardiographic pattern. The results suggest that esmolol may be able to improve the survival rate of patients with electrical storm in dilated cardiomyopathy and should be considered as a primary therapy in the management of cardiac electrical storms.

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1	Conti S, Pala S, Biagioli V, Del Giorno G, Zucchetti M, Russo E, Marino V, Dello Russo A, Casella M, Pizzamiglio F, et al: Electrical storm: A clinical and electrophysiological overview. World J Cardiol. 26:555–561. 2015.
2	Sesselberg HW, Moss AJ, McNitt S, Zareba W, Daubert JP, Andrews ML, Hall WJ, McClinitic B and Huang DT: MADIT-II Research Group: Ventricular arrhythmia storms in postinfarction patients with implantable defibrillators for primary prevention indications: A MADIT-II substudy. Heart Rhythm. 4:1395–1402. 2007. View Article : Google Scholar : PubMed/NCBI
3	Exner DV, Pinski SL, Wyse DG, Renfroe EG, Follmann D, Gold M, Beckman KJ, Coromilas J, Lancaster S and Hallstrom AP: AVID Investigators: Electrical storm presages nonsudden death: The antiarrhythmics versus implantable defibrillators (AVID) trial. Circulation. 103:2066–2071. 2001. View Article : Google Scholar : PubMed/NCBI
4	Davis JE, Curtis LA and Rashid H: Idiopathic cardiac electrical storm. J Emerg Med. 37:264–268. 2009. View Article : Google Scholar : PubMed/NCBI
5	Marrouche NF, Verma A, Wazni O, Schweikert R, Martin DO, Saliba W, Kilicaslan F, Cummings J, Burkhardt JD, Bhargava M, et al: Mode of initiation and ablation of ventricular fibrillation storms in patients with ischemic cardiomyopathy. J Am Coll Cardiol. 43:1715–1720. 2004. View Article : Google Scholar : PubMed/NCBI
6	Koplan BA and Stevenson WG: Ventricular tachycardia and sudden cardiac death. Mayo Clin Proc. 84:289–297. 2009. View Article : Google Scholar : PubMed/NCBI
7	ECC Committee, Subcommittees Task Forces of the American Heart Association 2005 American Heart Association: Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 112:IV1–IV203. 2005.PubMed/NCBI
8	Mittadodla PS, Salen PN and Traub DM: Isoproterenol as an adjunct for treatment of idiopathic ventricular fibrillation storm in a pregnant woman. Am J Emerg Med. 30:251.e3–e5. 2012. View Article : Google Scholar
9	Miwa Y, Ikeda T, Mera H, Miyakoshi M, Hoshida K, Yanagisawa R, Ishiguro H, Tsukada T, Abe A, Yusu S and Yoshino H: Effects of landiolol, an ultra-short-acting beta1-selective blocker, on electrical storm refractory to class III antiarrhythmic drugs. Circ J. 74:856–863. 2010. View Article : Google Scholar : PubMed/NCBI
10	Bänsch D, Oyang F, Antz M, Arentz T, Weber R, Val-Mejias JE, Ernst S and Kuck KH: Successful catheter ablation of electrical storm after myocardial infarction. Circulation. 108:3011–3016. 2003. View Article : Google Scholar : PubMed/NCBI
11	Yusu S, Ikeda T, Mera H, Miyakoshi M, Miwa Y, Abe A, Tsukada T, Ishiguro H, Shimizu H and Yoshino H: Effects of intravenous nifekalant as a lifesaving drug for severe ventricular tachyarrhythmias complicating acute coronary syndrome. Circ J. 73:2021–2028. 2009. View Article : Google Scholar : PubMed/NCBI
12	Remo BF, Preminger M, Bradfield J, Mittal S, Boyle N, Gupta A, Shivkumar K, Steinberg JS and Dickfeld T: Safety and efficacy of renal denervation as a novel treatment of ventricular tachycardia storm in patients with cardiomyopathy. Heart Rhythm. 11:541–546. 2014. View Article : Google Scholar : PubMed/NCBI
13	Stefanelli CB, Bradley DJ, Leroy S, Dick M II, Serwer GA and Fischbach PS: Implantable cardioverter defibrillator therapy for life-threatening arrhythmias in young patients. J Interv Card Electrophysiol. 6:235–244. 2002. View Article : Google Scholar : PubMed/NCBI
14	Gatzoulis KA, Andrikopoulos GK, Apostolopoulos T, Sotiropoulos E, Zervopoulos G, Brili S and Stefanadis CI: Electrical storm is an independent predictor of adverse long-term outcome in the era of implantable defibrillator therapy. Europace. 7:184–192. 2005. View Article : Google Scholar : PubMed/NCBI
15	Meregalli P, Wilde A and Tan H: Pathophysiological mechanisms of Brugada syndrome: Depolarization disorder, repolarization disorder, or more? Cardiovasc Res. 67:367–378. 2005. View Article : Google Scholar : PubMed/NCBI
16	Bettiol K, Gianfranchi L, Scarfo S, Pacchioni F, Pedaci M and Alboni P: Successful treatment of electrical storm with oral quinidine in Brugada syndrome. Ital Heart J. 6:601–602. 2005.PubMed/NCBI
17	Kowey PR: An overview of antiarrhythmic drug management of electrical storm. Can J Cardiol. 12:3B–8B. 1996.PubMed/NCBI
18	Van Herendael H and Dorian P: Amiodarone for the treatment and prevention of ventricular fibrillation and ventricular tachycardia. Vasc Health Risk Manag. 6:465–472. 2010.PubMed/NCBI
19	Kurisu K, Hisahara M, Onitsuka H, Sekiya M, Ikeuchi M, Kozai T and Urabe Y: Nifekalant hydrochloride terminated electrical storms after coronary surgery. Ann Thorac Surg. 89:1637–1639. 2010. View Article : Google Scholar : PubMed/NCBI
20	Sorajja D, Munger TM and Shen WK: Optimal antiarrhythmic drug therapy for electrical storm. J Biomed Res. 29:20–34. 2015.PubMed/NCBI
21	Eifling M, Razavi M and Massumi A: The evaluation and management of electrical storm. Tex Heart Inst J. 38:111–121. 2011.PubMed/NCBI
22	Richardson P, McKenna W, Bristow M, Maisch B, Mautner B, O'Connell J, Olsen E, Thiene G, Goodwin J, Gyarfas I, et al: Report of the 1995 World Health Organization/International Society and Federation of Cardiology task force on the definition and classification of cardiomyopathies. Circulation. 93:841–842. 1996. View Article : Google Scholar : PubMed/NCBI
23	Silva Marques J, Veiga A, Nóbrega J, Correia MJ and de Sousa J: Electrical storm induced by H1N1 A influenza infection. Europace. 12:294–295. 2010. View Article : Google Scholar : PubMed/NCBI
24	Balcells J, Rodriguez M, Pujol M and Iglesias J: Successful treatment of long QT syndrome-induced ventricular tachycardia with esmolol. Pediatr Cardiol. 25:160–162. 2004. View Article : Google Scholar : PubMed/NCBI
25	Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW and Andrews ML: Multicenter Automatic Defibrillator Implantation Trial II Investigators: Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 346:877–883. 2002. View Article : Google Scholar : PubMed/NCBI
26	Nademanee K, Taylor R, Bailey WE, Rieders DE and Kosar EM: Treating electrical storm: Sympathetic blockade versus advanced cardiac life support-guided therapy. Circulation. 102:742–747. 2000. View Article : Google Scholar : PubMed/NCBI
27	Lombardi F, Verrier RL and Lown B: Relationship between sympathetic neural activity, coronary dynamics and vulnerability to ventricular fibrillation induced by myocardial ischemia and reperfusion. Am Heart J. 105:958–965. 1983. View Article : Google Scholar : PubMed/NCBI
28	Zipes DP: Influence of myocardial ischemia and infarction on autonomic innervation of heart. Circulation. 82:1095–1105. 1990. View Article : Google Scholar : PubMed/NCBI
29	Hershberger RE, Morales A and Siegfried JD: Clinical and genetic issues in dilated cardiomyopathy: A review for genetics professionals. Genet Med. 12:655–667. 2010. View Article : Google Scholar : PubMed/NCBI
30	Streitner F, Herrmann T, Kuschyk J, Lang S, Doesch C, Papavassiliu T, Streitner I, Veltmann C, Haghi D and Borggrefe M: Impact of shocks on mortality in patients with ischemic or dilated cardiomyopathy and defibrillators implanted for primary prevention. PLoS One. 8:e639112013. View Article : Google Scholar : PubMed/NCBI
31	Kolettis TM, Naka KK and Katsouras CS: Radiofrequency catheter ablation for electrical storm in a patient with dilated cardiomyopathy. Hellenic J Cardiol. 46:366–369. 2005.PubMed/NCBI
32	Takigawa M, Noda T, Kurita T, Aihara N, Yamada Y, Okamura H, Satomi K, Suyama K, Shimizu W and Kamakura S: Predictors of electrical storm in patients with idiopathic dilated cardiomyopathy - how to stratify the risk of electrical storm. Circ J. 74:1822–1829. 2010. View Article : Google Scholar : PubMed/NCBI
33	Burjorjee JE and Milne B: Propofol for electrical storm; a case report of cardioversion and suppression of ventricular tachycardia by propofol. Can J Anaesth. 49:973–977. 2002. View Article : Google Scholar : PubMed/NCBI