Sepsis is the most frequent trigger for electrical storm in structural heart disease: results from a tertiary referral centre prospective registry

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Electrical storm is a specific clinical presentation yielding to high morbidity and mortality. Acute development of electrical storms results from the underlying myocardial substrate, autonomic activation, and trigger factors. Main therapeutic approaches range from pharmacological to interventional treatment. METHODS: We enrolled in a prospective single center registry all patients admitted from March 2018 to March 2022 at our Centre who satisfied diagnostic criteria for electrical storm. Demographic, instrumental, and interventional data were obtained from local electronic health record. RESULTS: A total of 87 patients (79% male sex, mean age 72,21±10,49 years) were enrolled. Mean left ventricular ejection fraction was 37,27±11,62%. Underlying cardiomyopathy was ischemic in 57,47%; dilated cardiomyopathy in 20,69%, arrhythmogenic cardiomyopathy in 8%, other in 13,84%. A definite trigger was identified in 34 cases (39%), most frequent ones were sepsis (11 events, 32,4%), acute heart failure (6 events, 17,6%), myocardial ischemia (5 events, 14,7%), thyrotoxicosis (5 events, 14,7%), ionic disorder (4 events, 11,8%). An ICD was already implanted in 89,66% of patients, all remaining patients were implanted during index hospitalization. An ablation strategy was pursued in 65,52% of cases. Mean days from hospitalization to ablation were 7±5. Median hospital stay was 11 days (IQR 8-18). CONCLUSION: In our single referral centre experience, in patients with electrical storm, ischemic cardiomyopathy was the dominant underlying heart disease. An identifiable trigger was found in a large cohort of patients, with sepsis being the most frequent. An ablation strategy was pursued in most cases.