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To study the cause and characteristics of ventricular electrical storm (VES) during the percutaneous coronary intervention (PCI) and the emergency rescue of VES.
The cause and characteristics, direct current cardioversion (DC) and the use of anti-arrhythmic drugs for 36 patients with VES during PCI was studied from January, 2010 to January, 2016. Among 36 cases there were male 24(66.7%) and female 12(33.3%). Age of the patients was 43 to 77 (mean 63.8 ± 9.7) years old. There were 21 cases (58.3%) with hypertension, 23 cases (63.9%) with diabetes, 7 cases (19.4%) with old myocardial infarction (OMI), and 22 (61.1%) smokers. Of them 30 patients (83.3%) suffered from acute ST segment elevation myocardial infarction (STEMI) and 6 patients (16.7%) suffered from non ST-elevation acute coronary syndrome (NST-ACS). Coronary angiography showed 13 cases (36.1%) with left anterior descending branch occlusion, 8 cases (22.2%) with left circumflex branch occlusion, 15 cases (41.7%) with right coronary artery occlusion and 3 cases with left main coronary artery (LM) occlusion. The routine PCI and stenting for all patients were performed. During PCI procedure heparin sodium 100u/kg was injected from the arterial sheath catheter. After PCI the loading doses of aspirin 300 mg and clopidogrel 300 mg were immediately application. Right ventricle pacing was used to the patients with sinus arrest, bradycardia and II or III degree atrioventricular block.
During PCI paroxysmal ventricular tachycardia (VT) and ventricular fibrillation (Vf) occurred two or more than two times in 30 patients with STEMI. VT and Vf happened in 26 cases (86.7%) when the infarction related artery (IRA) was opened lasting for 10-20 seconds. Vf happened in 4 cases with STEMI before PCI procedure. Vf occurred in 6 patients with NST-ACS after acute target coronary artery occlusion during PCI procedure. VT lasting for 5 seconds to 20 seconds induced Vf in 23 cases (63.9%). The ventricular premature beat (PVC) induced Vf in 13 cases (36.1%). The intravenous application of amiodarone, lidocaine or esmolol was effect on some patients with VT and Vf. All patients with Vf received two-way wave 200 joules DC shock including 2 cases with inferior wall STEMI who received 40 times and 58 times of DC shock (An average of six times of DC shock per case) was performed. Rescue survived patients was 31 cases (86.1. %). 5 cases (13.9%) died of cardiogenic shock. All survivors received stent implantation and regular oral tartaric acid metoprolol and dual antiplatelet. During the follow-up from 6 to 37 months (mean 26 months) VES did not happened again.
During PCI procedure VES are caused by acute myocardial ischemia leading to electrical instability and excessive activation of the sympathetic nervous. Characteristics of VES are prone to occur in 20 seconds of IRA opening. DC shock is primary measures and should be rapid implementation on the basis of anti-arrhythmic drugs. Beta blocker is effect on the prevent of Vf.