Treating electrical storm - Sympathetic blockade versus advanced cardiac life support-guided therapy

Background-Electrical storm (ES), defined as recurrent multiple ventricular fibrillation (VF) episodes, often occurs in patients with recent myocardia l infarction. Because treating ES according to the Advanced Cardiac Life Su pport (ACLS) guidelines yields a poor outcome, we evaluated the efficacy of sympathetic blockade in treating ES patients and compared their outcome wi th that of patients treated according to the ACLS guidelines. Methods and Results-Forty-nine patients (36 men, 13 women, mean age 57+/-10 years) who had ES associated with a recent myocardial infarction were sepa rated into 2 groups. Patients in group 1 (n=27) received sympathetic blocka de treatment: 6 left stellate ganglionic blockade, 7 esmolol, and 14 propra nolol. Patients in group 2 (n=22) received antiarrhythmic medication as rec ommended by the ACLS guidelines. Patient characteristics were similar in th e 7, groups. The 1-week mortality rate was higher in group 2: is (82%) of t he 22 patients died, all of refractory VF; 6 (22%) of the 27 group 1 patien ts died, 3 of refractory VF (P<0.0001). Patients who survived the initial E S event did well over the 1-year follow-up period: Overall survival in grou p 1 was 67%, compared with 5% in group 3 (P<0.0001). Conclusions-Sympathetic blockade is superior to the antiarrhythmic therapy recommended by the ACLS guidelines in treating ES patients. Our study empha sizes the role of increased sympathetic activity in the genesis of ES. Symp athetic blockade - not class 1 antiarrhythmic drugs - should be the treatme nt of choice for ES.