Circadian and Weekly Patterns of Electrical Storm
A Role for Stress?
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Electrical storm (ES) worsens morbidity, mortality, and quality of life in patients with implantable cardioverter-defibrillators (ICDs). The reported incidence of ES varies widely depending on definition used, underlying cardiac pathology, and device programming but ranges between 2% and 10% per year, ≤20% in patients with ICDs implanted for secondary prevention.1–3 ES generally portends a poor prognosis, associated with an elevated risk of death that ranges between 2.4- and 7.4-fold increase, with risk during the first 3 months as high as a 17.8-fold.1,2,4,5 Hospitalization also increases after ES, at a rate 3× that in patients suffering an isolated ventricular tachyarrhythmia.6 Psychologically, multiple shocks can be devastating. While psychopathology specifically after ES has not been described, in general, receipt of >5 shocks is associated with an increase in both anxiety and depression and a reduction in both physical and mental health.1,7
See Article by Guerra et al
Despite the deleterious impacts on morbidity, mortality, and quality of life, there are few data evaluating potential triggers for ES, which may lead to mechanistic understanding and ultimately point to novel therapies. The TEMPEST trial (Temperature-Related Incidence of Electrical Storm), reported by Guerra et al8 in this month’s Circulation: Arrhythmia and Electrophysiology, examined temporal patterns and potential environmental triggers for ES and demonstrated a heterogeneous incidence of ES with a clustered pattern. They demonstrated the prevalence of ES to be significantly higher during work days and during morning hours. Their findings are highly suggestive of possible autonomic triggering mechanisms for …