Introducción:

Existe escasa evidencia sobre la evolución de los pacientes portadores de desfibrilador por prevención primaria tras una tormenta arrítmica. Se pretende describir la tasa de la misma, características basales y evolución de este subgrupo comparada con aquellos sin tormenta arrítmica.

Métodos:

Estudio multicéntrico retrospectivo realizado en 15 hospitales españoles. Cada centro incluyó consecutivamente a los pacientes sometidos a implante de desfibrilador en prevención primaria durante al menos 2010 y 2011.

Resultados:

De 1,174 pacientes, 34 (2.9%) presentaron un episodio de tormenta arrítmica, principalmente secundaria a taquicardia ventricular (82.4%). No se detectaron diferencias basales entre aquellos con y sin tormenta, presentando similar puntuación en los scores de mortalidad (SHOCKED, MADIT y FADES). Se identificó un posible trigger en el 47% de los eventos. Durante un seguimiento medio de 38 ± 21 meses, 20 pacientes fallecieron por cualquier causa (58.8%) frente a 165 (14.4%) de la población sin tormenta arrítmica (p < 0.001). De estos, 18 (52.9%) fallecieron por causa de origen cardiovascular frente a 98 pacientes (8.6%) (p < 0.001). Presentaron asimismo mayor tasa de terapias inapropiadas que el grupo sin tormenta (14,7 versus 8.6%; p < 0.001).

Conclusiones:

En la presente muestra de pacientes con desfibrilador por prevención primaria la tasa de tormenta arrítmica fue del 2.9%. No se objetivaron diferencias basales entre pacientes con historia de tormenta arrítmica frente a aquellos sin ella. Sin embargo, hubo diferencias en la tasa de mortalidad de cualquier causa, de origen cardiovascular y terapias inapropiadas.

Introduction:

Little is known about the prevalence of electrical storm, baseline characteristics and mortality implications of patients with implantable cardioverter defibrillator in primary prevention versus those patients without electrical storm. We sought to assess the prevalence, baseline risk profile and survival significance of electrical storm in patients with implantable defibrillator for primary prevention.

Methods:

Retrospective multicenter study performed in 15 Spanish hospitals. Consecutives patients referred for desfibrillator implantation, with or without left ventricular lead (at least those performed in 2010 and 2011), were included.

Results:

Over all 1,174 patients, 34 (2,9%) presented an electrical storm, mainly due to ventricular tachycardia (82.4%). There were no significant baseline differences between groups, with similar punctuation in the mortality risk scores (SHOCKED, MADIT and FADES). A clear trigger was identified in 47% of the events. During the study period (38 ± 21 months), long-term total mortality (58.8% versus 14.4%, p < 0.001) and cardiac mortality (52.9% versus 8.6%, p < 0.001) were both increased among electrical storm patients. Rate of inappropriate desfibrillator intervention was also higher (14.7 versus 8.6%, p < 0.001).

Conclusions:

In the present study of patients with desfibrillator implantation for primary prevention, prevalence of electrical storm was 2.9%. There were no baseline differences in the cardiovascular risk profile versus those without electrical storm. However, all cause mortality and cardiovascular mortality was increased in these patients versus control desfibrillator patients without electrical storm, as was the rate of inappropriate desfibrillator intervention.

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