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

• Published in: European heart journal. Acute cardiovascular care 2020-09, Vol.9 (6), p.657-664
• Main Authors: Bundgaard, Johan S, Jacobsen, Peter K, Grand, Johannes, Lindholm, Matias G, Hassager, Christian, Pehrson, Steen, Kjaergaard, Jesper, Bundgaard, Henning
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anti-Arrhythmia Agents - therapeutic use; Autonomic Nervous System - physiopathology; Child; Deep Sedation - methods; Defibrillators, Implantable; Electrocardiography; Female; Follow-Up Studies; Heart Rate - physiology; Humans; Male; Middle Aged; Prognosis; Retrospective Studies; Tachycardia, Ventricular - physiopathology; Tachycardia, Ventricular - therapy; Young Adult
• ISSN: 2048-8726; 2048-8734
• DOI: 10.1177/2048872620903453

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.