Bolus potassium in frustrated ventricular fibrillation storm

Ventricular electrical storm (VES) is a clinical scenario characterized by the clustering of multiple episodes of sustained ventricular arrhythmias (VA) over a short duration. Patients with VES are prone to psychological disorders, heart failure decompensation, and increased mortality. Studies have shown that 10–28% of the patients with secondary prevention ICDs can sustain VES. The triad of a susceptible electrophysiologic substrate, triggers, and autonomic dysregulation govern the pathogenesis of VES. The rate of VA, underlying ventricular function, and the presence of implantable cardioverter-defibrillator (ICD) determine the clinical presentation. A multi-faceted approach is often required for management consisting of acute hemodynamic stabilization, ICD reprogramming when appropriate, antiarrhythmic drug therapy, and sedation. Some patients may be eligible for catheter ablation, and autonomic modulation with thoracic epidural anesthesia, stellate ganglion block, or cardiac sympathetic denervation. Hemodynamically unstable patients may benefit from the use of left ventricular assist devices, and extracorporeal membrane oxygenation. Special scenarios such as idiopathic ventricular fibrillation, Brugada syndrome, Long and short QT syndrome, early repolarization syndrome, catecholaminergic polymorphic ventricular tachycardia, arrhythmogenic right ventricular cardiomyopathy, and cardiac sarcoidosis have been described as well. VES is a cardiac emergency that requires swift intervention. It is associated with poor short and long-term outcomes. A structured team-based management approach is paramount for the safe and effective treatment of this sick cohort.

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Bolus potassium in frustrated ventricular fibrillation storm: Evidence are growing!

Elmahrouk

Elghaysha

Arafat

et al. 2020

J Card Surg

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In reference to the letter from Jouffroy et al, regarding our case report, 1 we do agree that intravenous potassium should be considered as an option for the management of refractory ventricular fibrillation (VF) after further studies. Studies on the role of potassium in the management of refractory VF are limited. 2 Potassium was used to convert VF after aortic declamping 3 ; however, the role of potassium during cardiopulmonary resuscitation was not established. Our patient was on extracorporeal membrane oxygenation with normal potassium levels. 4 We used intravenous potassium aiming to induce diastolic cardiac arrest through hyperkalemia, however unexpectedly, the rhythm was converted to sinus rhythm. The successful use of potassium to convert post cardiopulmonary bypass VF and this case report should encourage future studies on the role of potassium in the management of refractory VF.

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Bolus potassium in frustrated ventricular fibrillation storm

Cited by 4 publications

References 10 publications

Bolus intravenous potassium chloride for recurrent ventricular fibrillation

Bolus intravenous potassium chloride for recurrent ventricular fibrillation

Management of ventricular electrical storm: a contemporary appraisal

Bolus potassium in frustrated ventricular fibrillation storm: Evidence are growing!

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