Effectiveness of amiodarone and lidocaine combination in termination of monomorphic ventricular tachycardia electrical storm in patient with dilated cardiomyopathy and severe left ventricular dysfunction

Abstract

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.

Neuraxial Modulation in Electrical Storm: A Case Report

“…The duration and dose of these two agents for ES are driven predominantly by experience and case series-based recommendations compared to powered studies that were done for their use during ACLS. 8 Amiodarone is deemed safe for parenteral use for a period longer than 14 days based on the product monograph (maximum of 720 mg/day), while the same can't be said for the use of lignocaine parenteral infusions. 9,10 The effectiveness of the combination of these medications in ES management is likely due to the combined blockage of sodium and potassium channels.…”