Electrical storm and incessant ventricular tachycardia
- Rod Passman, MD, MSCE
Rod Passman, MD, MSCE
- Professor of Medicine
- Northwestern University Feinberg School of Medicine
Electrical storm, also referred to as arrhythmic storm, refers to multiple recurrences of ventricular arrhythmias over a short period of time. In most instances, the arrhythmia is ventricular tachycardia (VT), but polymorphic VT and ventricular fibrillation (VF) can also result in electrical storm. The arrhythmias can be self-terminating but frequently are terminated using antiarrhythmic drugs or device-related therapies (defibrillation or anti-tachycardia pacing).
In contrast to repetitive ventricular arrhythmias occurring in electrical storm, incessant VT is defined as hemodynamically stable VT which persists for longer than one hour.
This topic will discuss the incidence, triggers, clinical significance and treatment of electric storm and incessant VT. The general approach to the diagnosis and management of VT, as well as the use of implantable cardioverter-defibrillators, are discussed separately in various topics. (See "Sustained monomorphic ventricular tachycardia: Clinical manifestations, diagnosis, and evaluation" and "Sustained monomorphic ventricular tachycardia in patients with a prior myocardial infarction: Treatment and prognosis" and "Primary prevention of sudden cardiac death in heart failure and cardiomyopathy" and "Secondary prevention of sudden cardiac death in heart failure and cardiomyopathy".)
Electrical storm refers to a state of cardiac electrical instability characterized by multiple episodes of ventricular tachycardia (VT storm) or ventricular fibrillation (VF storm) within a relatively short period of time, typically 24 hours . The clinical definition of electrical storm is varied, somewhat arbitrary, and is a source of ongoing debate .
●In patients without an implantable cardioverter-defibrillator (ICD), electrical storm has been variously defined as [1,3-5]:
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- TRIGGERS OF ELECTRICAL STORM
- CLINICAL PRESENTATION
- Electrocardiographic monitoring
- Type of ventricular arrhythmia
- DIFFERENTIAL DIAGNOSIS
- Initial management
- - ACLS and defibrillation
- - Amiodarone and beta blockers
- - Coronary revascularization
- Subsequent management
- - Catheter ablation
- - Maintenance antiarrhythmic therapy
- - Other general therapies
- - Condition-specific therapies
- - Management of refractory cases
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS