Clinical Outcomes of Concurrent Ventricular Electrical Storm and Infection (JCEP September 2025)-Article: Clinical Outcomes of Concurrent Ventricular Electrical Storm and Infection

Article: Clinical Outcomes of Concurrent Ventricular Electrical Storm and Infection

Pdf Summary

This retrospective study analyzed 309 patients with ventricular electrical storm (ES) admitted to Vanderbilt University Medical Center from 2004 to 2022, focusing on the impact of concurrent infection on clinical outcomes. ES, characterized by multiple life-threatening ventricular arrhythmias within 24 hours, often occurs in patients with structural heart disease. The cohort was divided into infection (68 patients) and non-infection (241 patients) groups, with infection defined as occurring within 10 days before or 30 days after ES onset.<br /><br />Key findings include:<br /><br />1. Prevalence and Characteristics: 22% of ES patients had concurrent infection; 28 had bacteremia, most commonly caused by methicillin-resistant Staphylococcus aureus. Thirteen patients had cardiac implantable electronic device (CIED) infections, including infective endocarditis cases.<br /><br />2. Mortality and Predictors: The infection group had significantly higher all-cause mortality at 2 years (50% vs. 27%) and cardiovascular mortality compared to the non-infection group. Bacteremia emerged as a strong independent predictor of mortality (OR ~5.2), along with decreased left ventricular ejection fraction (LVEF).<br /><br />3. Infection Timing and Iatrogenic Risk: Notably, 65% of infections developed after ES onset, suggesting potential iatrogenic infections related to prolonged hospitalization, intravenous lines, mechanical ventilation, or invasive procedures such as VT ablation and catheterization. Among patients without preceding infection symptoms, 5.3% developed bacteremia post-ES, and 2.5% required lead extraction for CIED infection.<br /><br />4. Clinical Implications: Infection, particularly bacteremia, appears to worsen ES prognosis, possibly due to sympathetic activation, inflammation, and heart failure exacerbation. Patients with infection had longer hospital stays, more severe heart failure symptoms, and higher use of mechanical circulatory support.<br /><br />Study limitations include single-center design and potential confounding from disease severity. Nonetheless, the findings highlight the importance of infection prevention and management in patients with ES, given the associated increased mortality. Future prospective studies are needed to better understand causality and develop strategies to mitigate infection-related risks in this vulnerable population.

Keywords

ventricular electrical storm

infection

bacteremia

mortality

left ventricular ejection fraction

cardiac implantable electronic device

infective endocarditis

iatrogenic infection

mechanical circulatory support

ventricular arrhythmias