Electrical storm (ES) is a state of electrical instability, manifesting as recurrent ventricular arrhythmias (VAs) over a short period of time (three or more episodes of sustained VA within 24 h, separated by at least 5 min, requiring termination by an intervention). The clinical presentation can vary, but ES is usually a cardiac emergency. Electrical storm mainly affects patients with structural or primary electrical heart disease, often with an implantable cardioverter-defibrillator (ICD). Management of ES requires a multi-faceted approach and the involvement of multi-disciplinary teams, but despite advanced treatment and often invasive procedures, it is associated with high morbidity and mortality. With an ageing population, longer survival of heart failure patients, and an increasing number of patients with ICD, the incidence of ES is expected to increase. This European Heart Rhythm Association clinical consensus statement focuses on pathophysiology, clinical presentation, diagnostic evaluation, and acute and long-term management of patients presenting with ES or clustered VA.

• Klíčová slova
• Arrhythmia, Consensus document, Electrical storm, Sudden cardiac death, Ventricular fibrillation, Ventricular tachycardia,
• MeSH
• defibrilátory implantabilní * MeSH
• incidence MeSH
• komorová tachykardie * diagnóza   terapie   komplikace   MeSH
• lidé MeSH
• rizikové faktory MeSH
• srdeční arytmie diagnóza   terapie   MeSH
• srdeční selhání * komplikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Asie epidemiologie   MeSH

INTRODUCTION: Initiation of class III anti-arrhythmic medications requires telemetric monitoring for ventricular arrhythmias and QT prolongation to reduce the risk of torsades de pointes (TdP). Heart rate-corrected QT interval (QTc) is an indicator of risk, however it is imperfect, and subtle abnormalities of repolarization have been linked with arrhythmogenesis. PURPOSE: Identification of electrocardiographic predictors of torsadogenic risk through the application of a novel T wave analysis tool. METHODS: Among all patients admitted to Mayo Clinic for initiation of dofetilide or sotalol, we identified 13 cases who developed drug-induced TdP and 26 age and sex matched controls that did not develop TdP. The immediate pre-TdP ECG of those with TdP was compared to the last ECG performed prior to hospital discharge in controls using a novel T wave program that quantified subtle changes in T wave morphology. RESULTS: The QTc and 12 T wave parameters successfully distinguished TdP cases from controls. The top performing parameters were the QTc in lead V3 (mean case vs control 480 vs 420 msec, p < 0.001, r = 0.72) and T wave right slope in lead I (mean case vs control -840.29 vs -1668.71 mV/s, p = 0.002, r = 0.45). The addition of T wave right slope to QTc improved prediction accuracy from 79 to 88 %. CONCLUSION: Our data demonstrate that, in addition to QTc, the T wave right slope is correlated strongly with TdP risk. This suggests that a computer-based repolarization measurement tool that integrates additional data beyond the QTc may identify patients with the greatest torsadogenic potential.

• Klíčová slova
• Class III antiarrhythmics, Electrocardiography, Risk stratification, T wave analysis, Torsade de pointes,
• MeSH
• antiarytmika škodlivé účinky   MeSH
• elektrokardiografie metody   MeSH
• fenethylaminy škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prediktivní hodnota testů * MeSH
• senioři MeSH
• software * MeSH
• sotalol škodlivé účinky   MeSH
• studie případů a kontrol MeSH
• sulfonamidy škodlivé účinky   MeSH
• torsades de pointes chemicky indukované   prevence a kontrola   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antiarytmika MeSH
• dofetilide MeSH Prohlížeč
• fenethylaminy MeSH
• sotalol MeSH
• sulfonamidy MeSH