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Curr Trend Cardiol. 2017 | Volume 1 Issue 3
September 18-19, 2017 | Toronto, Canada
Annual Conference on
HEART DISEASES
Background:
Ventricular tachycardia (VT) storm is an
uncommon but life-threatening episode defined as 3 or
more sustained episodes of VT or VF requiring cardioversion
within 24 hours. We present here intermediate results of an
observational study on clinical profile and outcomes of 50
consecutive patients presenting with VT storm.
Purpose:
To evaluate the clinical profile, management
strategies and modalities of treatment in patient with VT
storm.
Methods:
This is a prospective observational cohort study,
undertaken at a tertiary care hospital in India. Data of 50
consecutive patients with confirmed diagnosis of VT storm
was collected for final analysis. Parameters assessed were
clinical history, primary diagnosis leading to VT, medication
history, comorbidities, implanted cardioverter device
(ICD) details, treatment modalities tried including cardiac
sympathetic denervation (CSD), subsequent hospitalization
and follow up ( ≥6 months) details.
Results:
50 patients (36men, 14 women, median age 55 (IQR,
46-65 years) were included in the study. The most frequent
substrate of VT stormwas scar caused by previous myocardial
infarction (20 patients, 40%). Other causes included old
myocarditis, hypertrophic cardiomyopathy, idiopathic
DCMP, arrhythmogenic RV cardiomyopathy, previous TOF
surgery, LQTs, idiopathic VT, VF and acute myocarditis. None
of the patients had any active ongoing ischemia as the
precipitant factor for VT storm. 43 patients (86%) already
had ICD. A majority of patients (27, 54%) had Pleomorphic
(≥3) morphologies of VT. Monomorphic VT was found in 19
(38%) and polymorphic VT in 4 (8%). The median duration
of hospital stay was 6 (IQR, 4-14) days. Seven (14%) patients
died in the index hospitalization and the remaining 43 (86%)
patients were discharged successfully, of which 41 (82%)
were alive at 6 months. There was significant reduction of
number of VT at 6 months of follow-up compared to number
of VT episodes prior to index hospitalization [(24, IQR15-40
vs. 1, IQR 1-3.5); p<0.0001). Optimization of dosage, addition
or deletion of a new antiarrhythmic drug, controlled VT in
29 (58%) of patients; the remaining 21 (42%) of patients
underwent bilateral CSD in addition to the protocol based
management of VT storm. None of the baseline parameters
were significantly associated with occurrence of VT storm or
with the intermediate term survival.
Conclusions:
A majority of VT storm patients were men.
Old MI was the substrate in 40 % of patients. Medical
management predominantly, adjustment of anti-arrhythmic
drugs helped control the VT storm in 58 % of patients. A
significant proportion of these patients required CSD as a
management strategy. The in-hospital mortality was 14 %
and 6 months survival was 82%.
e:
Aniruddha.Vyas@Medanta.orgClinical profile and intermediate term outcome of 50 consecutive patient of ventricular tachycardia
storm managed at a tertiary care center in India
Aniruddha Vyas
Medanta Superspeciality Hospital, India