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Bispebjerg Hospital - en del af Københavns Universitetshospital
Udgivet

Deep sedation as temporary bridge to definitive treatment of ventricular arrhythmia storm

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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  • Johan S Bundgaard
  • Peter K Jacobsen
  • Johannes Grand
  • Matias G Lindholm
  • Christian Hassager
  • Steen Pehrson
  • Jesper Kjaergaard
  • Henning Bundgaard
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BACKGROUND: Electrical storm and incessant ventricular tachycardia (VT) are characterized by the clustering of episodes of VT or ventricular fibrillation (VF) and are associated with a poor prognosis. Autonomic nervous system activity influences VT threshold, and deep sedation may be useful for the treatment of VT emergencies.

METHODS: We reviewed data from conscious patients admitted to our intensive care unit (ICU) due to monomorphic VT, polymorphic VT or VF at our tertiary center between 2010 and 2018.

RESULTS: A total of 46 conscious patients with recurrent ventricular arrhythmia, refractory to initial treatment, were referred to the ICU. The majority (n = 31) were stabilized on usual care. The remaining treatment-refractory 15 patients (57 years (range 9-74), 80% males, seven with implantable cardioverter-defibrillators) with VT/VF storm (n = 11) or incessant VT (n = 4) due to ischemic heart disease (n = 10), cardiomyopathy (n = 2), primary arrhythmia (n = 2) and one patient post valve surgery, were deeply sedated and intubated. A complete resolution of VT/VF within minutes to hours was achieved in 12 patients (80%), partial resolution in two (13%) and one (7%) patient died due to ventricular free-wall rupture. One patient with recurrent VT episodes needing repeated deep sedation developed necrotic caecum. No other major complications were seen. Thirteen (87%) patients were alive after a mean follow-up of 3.7 years.

CONCLUSION: Deep sedation was effective and safe for the temporary management of malignant VT/VF refractory to usual treatment. In emergencies, deep sedation may be widely accessible at both secondary and tertiary centers and a clinically useful bridge to definitive treatment of VT.

OriginalsprogEngelsk
TidsskriftEuropean heart journal. Acute cardiovascular care
Vol/bind9
Udgave nummer6
Sider (fra-til)657-664
Antal sider8
ISSN2048-8726
DOI
StatusUdgivet - sep. 2020

ID: 61897167