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ABSTRACT. Automatic implantable cardioverter/defibrillators (AICD) increase the life expectancy of patients with underlying cardiac disease in both the primary and secondary prevention of sudden cardiac death (SCD). Unfortunately, despite the continuing technological development of these devices, a large number of patients experience unpleasant effects caused by their defibrillator. Frequent discharges in response to incessant or recurrent ventricular tachycardia or fibrillation, the delivery of inappropriate shocks in the absence of ventricular tachycardia because of non life-threatening supraventricular tachycardias or environmental factors, are the most common negative events that can occur after the implantation of the defibrillator. The effective management of electrical storm requires an understanding of arrhythmia mechanisms, therapeutic options, device programming, and indications for radiofrequency catheter ablation. Initial management involves determining and correcting the underlying ischemia, the electrolyte imbalances, or other causative factors. Amiodarone and β-blockers, especially propranolol, effectively resolve arrhythmias in most patients. Nonpharmacologic treatment, including radiofrequency ablation, can control electrical storm in drug-refractory patients. Patients who have implantable cardioverter-defibrillators might experience multiple shocks and may require drug therapy and device reprogramming. pp. 13–22

Keywords: sudden cardiac death; implantable defibrillator; ventricular tachycardia; ventricular fibrillation; multiple shocks; electrical storm

Cristian Statescu
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Grigore T. Popa University of Medicine
Radu A. Sascau
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Grigore T. Popa University of Medicine

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