Background: Electrical storm (ES) is a cluster of sustained ventricular arrhythmias which may be caused by various triggers on the arrhythmic substrate. The association between infection and ES is unknown.
Objectives: To investigate the clinical profile and prognosis of concurrent ES and infection.
Methods: We retrospectively studied patients with ES between May 2004 and March 2022, divided into two groups: those with and without concurrent infection, comparing clinical outcomes and prognoses.
Results: A total of 309 patients with ES were included; 68 had concurrent infection, and 28 of these had bacteremia. Among those with bacteremia, Methicillin-resistant Staphylococcus aureus was the most common pathogen, with 9 patients (32.1%), and lead extraction was performed in 13 (46.4%). Among the patients who clearly did not have preceding infection, fifteen cases (5.3%) developed bacteremia after ES. During the two-year follow-up period, the infection group had significantly higher mortality than the non-infection group (Log-rank P < 0.001). Multivariate logistic regression analysis identified bacteremia (OR: 5.23, 95% CI 1.91-15.02, P = 0.001) and decreased left ventricular ejection fraction (LVEF) (each 1% increase, OR: 0.95, 95% CI 0.93-0.98, P = 0.002) as independent predictors of mortality.
Conclusions: Among patients with ES, those with concurrent infection have increased mortality. Of those presenting without infection, over five percent developed bacteremia after ES, raising the possibility of iatrogenic infection during prolonged hospitalization. Bacteremia and decreased LVEF are independent predictors of mortality.
Editor-in-Chief
Kalyanam Shivkumar, MD, PhD, FACC
CME Editor
Kenneth A. Ellenbogen, MD, FACC
Author
Jay Montgomery, MD
Important Dates
Date of Release: September 22, 2025
Term of Approval/Date of CME/MOC Expiration: September 21, 2026