Last update: April 2020


Definition

  The presence of at least 3 attacks of ventricular tachycardia (VT) or ventricular fibrillation in less than 24 hours.



Electrical Storm (ES)

  Monomorphic ventricular tachycardia (VT) is the most common ES-documented arrhythmia.



Vulnerable substrate for ES

  Acute or chronic myocardial ischemia

  Hypertrophic cardiomyopathy

  Fabry disease

  Arrhythmogenic right ventricular cardiomyopathy

  Valvular heart disease

  Cardiac tumors

  Myocarditis

  Sarcoidosis

  Long QT syndrome(LQTS).
Sympathetic blockade is important.

  Catecholaminergic polymorphic VT. Sympathetic blockade is important.

  Early repolarization syndrome
. Sympathetic stimulation is important.

  Brugada syndrome. Sympathetic stimulation is important.

  Short QT syndrome. Sympathetic stimulation is important.




Triggers for ES

  Acute myocardial ischemia

  New or worsened heart failure

  Noncompliance to antiarrhythmic medication

  Ventricular premature contraction

  T wave pacing

  Acute prolongation of QT interval.

  Drugs (Digoxin, Propofol, Epinephrine, etc.)

  Electrolyte abnormalities (Hypokalemia, etc.)

  Toxins (3,4-methylenedioxymethamphetamine (MDMA), excess ethanol consumption, etc.)




References

  American Journal of Therapeutics 2019;26:e257-e267.

  Transl Clin Pharmacol 2019;27:69-72. (free full-text)

  Acta Cardiol 2019;74:429-430.

  Case Rep Crit Care. 2019 Mar 7;2019:7825915. (free full-text)

  Saudi J Anaesth 2019;13:359-361. (free full-text)

  Circulation 2018;138:e272-e391. (free full-text)

  J Cardiovasc Pharmacol Ther 2018;23:142-148.

  Eur Heart J Case Rep 2017;1:ytx008. (free full-text)

  Med J Malaysia 2012;67:582-584.

  Heart Rhythm 2006;3:131-137. (free full-text)

  J Interv Card Electrophysiol 2003;9:401-403.

  Europace 2000;2:263-269.

  Pacing Clin Electrophysiol 1994;17:252-257.