• Zahid Aslam Awan
  • Mahmood ul Hassan
  • Kamran Bangash
  • Bakhtawar Shah
  • Lubna Noor


Background: Prevention of sudden cardiac death has always been a challenge for electrophysiologistsand to date, automatic implantable cardiovertor defibrillator (AICD) is found to be the only remedy.This device delivers an intracardiac shock whenever it senses a fatal ventricular arrhythmia in order toachieve sinus rhythm. If the delivery of these intracardiac shocks becomes frequent, the situation isdeclared as an electrical storm. This article deals with the frequency, precipitating factors andprevention of electrical storms. Methods: One hundred and ten episodes of electrical storms (a total of668 shocks) were retrospectively analysed in 25 recipients of automatic implantable cardioverterdefibrillators. ECG, echocardiography, serum electrolytes, urea and creatinine were done for all thepatients, and they were hospitalized for a minimum of 24 hours. Results: During the 3 year studyperiod, all the 25 patients with an implantable cardiovertor defibrillator, on an average, received oneshock per two years. However, 12 out of these 25 patients (50%) had more than two shocks within 24hours. Most of these patients with electrical storms were having active ischemia, electrolytesimbalances or renal failure. Conclusion: Electrical storms are common in patients with coronary arterydisease with impaired left ventricular functions. Ischemia, electrolytes imbalances and renal failurepredispose to the electrical storms. Electrical Storms are predictors of poor prognosis.Keywords: Electrical Storm (ES), Automatic Implantable Cardiovertor Defibrillator (AICD),Ventricular Tachycardia (VT), Ventricular Fibrillation (VF)


Greene HL, Roden DM, Katz RJ, Woosley RL, Salerno DM,

Henthorn RW. The Cardiac Arrhythmia Suppression Trial

(CAST). J Am Coll Cardiol 1992;19:894–8.

Mark DB, Nelson CL, Anstrom KL, Al khatib SM, Tsiatis AA,

Cowper PA. Cost effectiveness of defibrillation therapy or

amiodarone in chronic stable heart failure: Results from the

Sudden Cardiac death in Heart Failure Trial (SCD-HeFT).

Circulation 2006;114(2):135–42.

Antiarrhythmics versus Implantable Defibrillators (AVID)

Investigators. A comparison of antiarrhythmic-drug therapy with

implantable defibrillators in patients resuscitated from near-fatal

ventricular arrhythmias. N Engl J Med 1997;337:1576–83.

Connolly SJ, Gent M, Roberts RS. Canadian Implantable Defibrillator Study (CIDS): a randomized trial of the implantable

cardioverter defibrillator against amiodarone. Circulation


Moss AJ, Hall WJ, Cannom DS. Improved survival with an

implanted defibrillator in patients with coronary disease at high

risk for ventricular arrhythmia: Multicenter Automatic

Defibrillator Implantation Trial Investigators. N Engl J Med


Buxton AE, Lee KL, Fisher JD. A randomized study of the

prevention of sudden death in patients with coronary artery

disease: Multicenter Unsustained Tachycardia Trial Investigators

N Engl J Med 1999;341:1882–90.

Mirowski M, Reid PR, Mower MM. Termination of malignant

ventricular arrhythmias with an implanted automatic defibrillator

in human beings. N Engl J Med 1980;303:322–4.

Villacastin J, Almendral J, Arenal A. Incidence and clinical

significance of multiple consecutive, appropriate, high-energy

discharges in patients with implanted cardioverter defibrillators.

Circulation. 1996;93:753–62.

Israel CW, Barold SS. Electrical storm in patients with an

implanted defibrillator: matter of definition. Ann Noninvasive

Electrocardiol 2007;12(4):375–82.

Credner SC, Klingenheben T, Mauss O, Susanne C. Electrical

storm in patients with transvenous implantable cardioverterdefibrillators: incidence, management and prognostic

implications. J Am Coll Cardiol 1998;32:1909–15.

Derek V. Exner, Sergio L. Pinski, D. Electrical Storm Presages

Nonsudden Death the Antiarrhythmics versus Implantable

Defibrillators (AVID) Trial. Circulation 2001;103;2066–71.

Moss AJ, ZarebaW, Hall WJ, Klein H, Wilber DJ, Cannom DS.

Prophylactic implantation of a defibrillator in patients with

myocardialinfarction and reduced ejection fraction. N Engl J

Med 2002;346:877–83.

Kendall MJ, Lynch KP, Hjalmarson, Kjekshus J. Beta-blockers

and Sudden Cardiac Death. Ann Intern Med 1995;123:358–67.

Vyas AK, Guo H, Moss AJ, Olshansky B. Reduction in

ventricular tachyarrhythmias with statins in the Multicenter

Automatic Defibrillator Implantation Trial (MADIT)-II. J Am

Coll Cardiol 2006;47(4):769–73.

Herre JM, Sauve MJ, Malone P. Long term results of amiodarone

therapy in patients with recurrent sustained ventricular

tachycardiaor ventricular fibrillation. J Am Coll Cardiol


Avitall B, Port S, Gal R. Automatic implantable cardioverter/

defibrillator discharges and acute myocardial injury. Circulation


Carbucicchio C, Santamaria M, Trevisi N, Maccabelli G, Giraldi

F, Fassini G. Catheter Ablation for the treatment of Electrical

Storm in Patients with Implantable Cardioverter-Defibrillators.

Circulation 2008;117:462–9.

Barnay C; Taieb J; Morice R. Electrical storm. Ann Cardiol

Angeiol (Paris) 2007;56(5):183–7.

Israel CW; Barold SS. Electrical storm in patients with an

implanted defibrillator: a matter of definition. Ann Noninvasive

Electrocardiol 2007;12(4):375–82.



Most read articles by the same author(s)

1 2 3 > >>