Electrical Storm: Case Series and Review of Management

Abstract

Electrical storm is defined as a recurrent episode of hemodynamically destabilizing ventricular tachyarrhythmia that usually requires electrical cardioversion or defibrillation. We describe three cases presenting with electrical storm under differing circumstances: (1) a 57-year-old man with ST-elevation myocardial infarction within 1 week of a posterior circulation stroke who developed refractory sustained ventricular tachycardia 10 days after an acute myocardial infarction; (2) a 65-year-old man who developed polymorphic ventricular tachycardia and ventricular fibrillation following dobutamine echocardiography; and (3) a 20-year-old woman who developed intractable ventricular fibrillation following an overdose of a weight-reduction pill. The management of electrical storm is discussed, and evolving literature supporting the routine use of intravenous amiodarone and beta-blockers in place of intravenous lidocaine is critically examined.

Idiopathic Cardiac Electrical Storm

“…It typically requires treatment with electrical cardioversion or defibrillation (2). It is a life-threatening dysrhythmia that frequently affects high-risk patients (3).…”

Should Catheter Ablation be the Preferred Therapy for Reducing ICD Shocks?

“…Many patients require addition of intravenous amiodarone followed by oral maintenance dosing to abort and prevent recurrent ventricular arrhythmia. 23,26 Such a strategy results in long-term outcomes similar to those seen in ICD patients without electrical storm. 23,26 Recent evidence suggests that the investigational agent azimilide may also be effective in prevention and treatment of electrical storm.…”

Should Catheter Ablation be the Preferred Therapy for Reducing ICD Shocks?

“…23,26 Such a strategy results in long-term outcomes similar to those seen in ICD patients without electrical storm. 23,26 Recent evidence suggests that the investigational agent azimilide may also be effective in prevention and treatment of electrical storm. 27 Additionally, some antiarrhythmic drugs may reduce the defibrillation threshold (DFT) and facilitate defibrillation of VT/VF, as discussed in later sections of this report.…”

“…Electrical storm, defined as 3 or more episodes of destabilizing VT/VF occurring in a 24-hour period, develops in Ϸ10% to 30% patients with ICD and is associated with increased morbidity and a higher 3-month mortality. [23][24][25] Prompt hospitalization with reversal of precipitating factors and optimization of ␤-blocker therapy is recommended in such cases. Many patients require addition of intravenous amiodarone followed by oral maintenance dosing to abort and prevent recurrent ventricular arrhythmia.…”