Electrical storm (ES) is a life-threatening condition that is defined by three or more episodes of sustained ventricular tachycardia (VT), ventricular fibrillation (VF), or appropriate shocks from an implantable cardioverter defibrillator (ICD) within 24 hours. The most common form of ES is monomorphic VT. It carries poor outcome despite all available intervention therapies. The therapies include rapid recognition of the condition, treatment of the reversible causes, ICD-reprogramming, antiarrhythmic drugs, sedation, and catheter ablation (CA). The first line antiarrhythmic drugs are amiodarone and β-blockers with superiority of propranolol over the others. The long-term use of the antiarrhythmic drugs is limited due to their adverse effects and drug-related proarrhythmic effect. The basic mechanism of monomorphic VT is re-entry pathway which can be targeted by CA. CA should be considered in drug refractory ES and patients should be referred in early course of disease. There are reported studies which showed the superiority of CA over the medical treatment in reducing the arrythmia burden and ICD appropriate shock. The survival benefit has been reported after successful ablation of ES in case series but to date no randomized control trial shows mortality benefit.

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Electrical storm is life threatening condition that is defined by ≥3 episodes of sustained ventricular tachycardia (VT), Ventricular fibrillation, or appropriate shocks from an ICD within 24h. In hospitals lacking electrophysiology service, the therapy includes rapid recognition of the condition, treatment of the reversible causes, immediate start of antiarrhythmic drugs and sedation. Catheter ablation should be considered in drug refractory electrical storm.we present a case of dilated cardiomyopathy with severe left ventricular dysfunction came with electrical storm of monomorphic ventricular tachycardia. He was found to have hyperkalemia and metabolic acidosis as precipitating factors which were aggressively treated. He received total of 43 electrical cardioversion shocks for hemodynamic unstable VT. Concomitant administration of intravenous infusion of amiodarone and lidocaine was an effective approach to control the electrical storm within24 h of starting both.