https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Münster Klinik für Kardiologie II - Rhythmologie Münster, Deutschland; 2Universitätsklinikum Münster Klinik für Kardiologie I: Koronare Herzkrankheit, Herzinsuffizienz und Angiologie Münster, Deutschland
Background:
Antiarrhythmic drug treatment is a cornerstone of the complex management of patients with an electrical storm (ES). Antiarrhythmic drug therapy is mainly limited to beta-blockers and amiodarone as only limited data on the safety and efficacy of other drugs such as ajmaline is available.
Antiarrhythmic drug treatment is a cornerstone of the complex management of patients with an electrical storm (ES). Antiarrhythmic drug therapy is mainly limited to beta-blockers and amiodarone as only limited data on the safety and efficacy of other drugs such as ajmaline is available.
Methods:
We retrospectively reviewed data from adult patients admitted to our intensive care unit (ICU) at our tertiary care centre due to ES between March 2013 and December 2023 who received ajmaline for therapy refractory ES.
We retrospectively reviewed data from adult patients admitted to our intensive care unit (ICU) at our tertiary care centre due to ES between March 2013 and December 2023 who received ajmaline for therapy refractory ES.
Results:
A total of 46 patients (age 64±11 years, 3 female) were admitted to the ICU for therapy of ES. All but one patient had a history of structural heart disease (LVEF 33±12%; 54% with an LVEF ≤ 30%; n=29 ischaemic cardiomyopathy, n=16 non-ischaemic cardiomyopathy). 36 patients had an implanted cardioverter defibrillator. Most patients (n=40) had sustained monomorphic ventricular tachycardia (VT) whereas recurrent polymorphic VT and ventricular fibrillation (VF) occurred in n=8 patients. Ajmaline was administered continuously in most patients (n=29 continuous infusion, n=16 continuous infusion and boli, n=1 boli). Complete suppression of VT/VF was achieved in n=34 patients (74%) with partial success in n=7 patients. In total, n=27 patients (59%) underwent additional VT ablation during the hospital stay.
A total of 46 patients (age 64±11 years, 3 female) were admitted to the ICU for therapy of ES. All but one patient had a history of structural heart disease (LVEF 33±12%; 54% with an LVEF ≤ 30%; n=29 ischaemic cardiomyopathy, n=16 non-ischaemic cardiomyopathy). 36 patients had an implanted cardioverter defibrillator. Most patients (n=40) had sustained monomorphic ventricular tachycardia (VT) whereas recurrent polymorphic VT and ventricular fibrillation (VF) occurred in n=8 patients. Ajmaline was administered continuously in most patients (n=29 continuous infusion, n=16 continuous infusion and boli, n=1 boli). Complete suppression of VT/VF was achieved in n=34 patients (74%) with partial success in n=7 patients. In total, n=27 patients (59%) underwent additional VT ablation during the hospital stay.
Ajmaline treatment failed in n=5 patients, of whom n=2 patients died due to multiple organ failure following refractory VT/VF. In one of these patients, VT ablation was performed with acute success, but VTs reoccurred during the ICU stay. No serious adverse events requiring discontinuation of ajmaline infusion were observed. Minor adverse events occurred in n=3 patients (n=1 widening of QRS complex <25%, n=1 mild hypotension, n=1 skin irritation). N=3 patients died due to a combined septic and cardiogenic shock despite complete (n=2) or partial (n=1) suppression of VT/VF by ajmaline treatment.
Conclusion:
The present study reports results on the in-hospital safety and acute efficacy of ajmaline in patients with refractory ES representing the largest case series to date. In a significant proportion of patients, treatment with ajmaline was successful in terminating VT/VF with an excellent safety profile. Ajmaline may serve as a clinically useful bridge to definitive VT treatment. Further prospective studies on ajmaline use in patients with refractory VT/VF are needed to identify the optimal therapeutic approach for this challenging patient group with poor prognosis.
The present study reports results on the in-hospital safety and acute efficacy of ajmaline in patients with refractory ES representing the largest case series to date. In a significant proportion of patients, treatment with ajmaline was successful in terminating VT/VF with an excellent safety profile. Ajmaline may serve as a clinically useful bridge to definitive VT treatment. Further prospective studies on ajmaline use in patients with refractory VT/VF are needed to identify the optimal therapeutic approach for this challenging patient group with poor prognosis.