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The cause and emergency rescue of ventricular electrical storm during primary PCI for patients with acute ST-elevation myocardial infarction

Objective: To explore the cause and emergency rescue of Ventricular Electrical Storm (VES) during primary PCI for patients with acute ST-Elevation Myocardial Infarction (STEMI).

Method: Among 796 patients with STEMI undergoing primary PCI 39 patients (4.9%) who happened to the VES during PCI procedure were studied. The causes, the characteristics of the coronary artery lesions, DC shock and the use of anti-arrhythmic drugs for patients with VES were analysed.

Results: The coronary angiography (CAG) showed 100% occlusion of Infarction Related coronary Artery (IRA) in all patients with STEMI. In 39 patients with VES 28 patients (71.8%) were characterized by mental tension and fear during PCI, and 11 cases (28.2%) happened to VES because of reperfusion arrhythmia. VES occurred from 3-48 times during PCI procedure. All patients with VES were characterized by ventricular fibrillation and were treated with DC shock. An average of six times of DC shock per case was performed. At the same time of DC anti-arrhythmic drugs were used such as lidocaine, amiodarone and esmolol. The rescue success was 33 cases (84.6%). 6 cases died (15.4%) of cardiac shock. The tartrate metoprolol was used regularly oral to maintain steady rhythm for all survivors. VES did not happen again after metoprolol was used in all survivors.

Conclusion: VES was easy happening for patients with STEMI and with mental tension and fear during PCI procedure. DC shock for the converting VES are primary measures, and should be rapid implementation on the basis of anti-arrhythmic drugs (especially β-blockers).

Author(s): Riufang Liu, Fangxing Xu, Tongku Liu, Hongyan Ma, Ming Gu, Fuxiang Ding, Shujie Wu, Lihua Xu