CANet — Cardiac Arrhythmia Network of Canada

Redefining Electrical Storm Based on Clinical Outcomes: Data from the RAFT Trial

Project Lead: Dr. Ihab Elsokkari, Electrophysiology Fellow, QE II Health Sciences Centre
Mentors: Dr. John Sapp (QE II Health Sciences Centre), Dr. Ratika Parkash (QEII Health Sciences Centre)
Amount: $10,000 (CANet)
Electrical storm is a state of cardiac electrical instability that manifests with clustered ventricular arrhythmia episodes within a short time frame. It was first described in
the era before the availability of implantable cardiac defibrillators (ICD) and the definition has evolved over time. With the widespread use of ICDs, the most commonly used definition of electrical storm currently is three or more episodes of ventricular arrhythmia requiring ICD therapy occurring within a 24-hour period.
The true incidence of electrical storm has not been clearly delineated in the literature due to the use of different definitions, variable follow-up periods and different study designs. It probably affects 10-20% of ICD patients with the reported incidence in the literature varying between 4% to 60%.
The reported mortality effect of electrical storm is also variable in the literature. Some studies reported no increased mortality while others reported significant increase in mortality from 30-50% in patients with electrical storm. A meta-analysis of the available evidence reported a 2.5-fold increase in mortality in patients with electrical storm compared to patients with unclustered sustained ventricular arrhythmia and a 3.3-fold increase in mortality compared to patients with no sustained ventricular arrhythmia.
We aim to define the cluster characteristics associated with increased mortality and heart failure hospitalization. This could help define a point where timely intervention might have the best opportunity to change clinical outcomes, thereby potentially preventing sudden cardiac death and heart failure.