Emergency Management of Electrical Storm: A Practical Overview

Guarracini, Fabrizio; Bonvicini, Eleonora; Zanon, Sofia; Martín, Marta Jiménez; Casagranda, Giulia; Mochen, Marianna; Coser, Alessio; Quintarelli, Silvia; Branzoli, Stefano; Mazzone, Patrizio; Bonmassari, Roberto; Marini, Massimiliano

doi:10.3390/medicina59020405

Cited by 4 publications

(5 citation statements)

References 113 publications

(125 reference statements)

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“…Our patient’s hemodynamic instability precluded such an approach [ 41 ]. Instead, we relied on a combination of antiarrhythmic medications and TTCP [ 9 ]. Although QTc prolongation did not improve, our patient remained stable for 40 hours with no further CAs until a TTCP dislodgment occurred, leading to her death.…”

Section: Discussionmentioning

confidence: 99%

“…Despite advances in treatment options, ES remains a clinical challenge, often presenting as a medical emergency [ 8 ]. Treatment strategies include antiarrhythmic medications, electrical cardioversion, and temporary transvenous cardiac pacing (TTCP) [ 9 , 10 ]. However, optimal management depends on the underlying etiology, the severity of the arrhythmias, and the patient’s overall clinical status [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Life-Threatening Electrical Storm Following Liver Transplantation: A Case Report

Araujo Coelho,

Oliveira da Luz,

Teixeira Basto

et al. 2023

Am J Case Rep

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Patient: Female, 61-year-old Final Diagnosis: Electrical storm Symptoms: Cardiac arrest • ventricular fibrillation Clinical Procedure: — Specialty: Cardiology • Critical Care Medicine • Gastroenterology and Hepatology • Transplantology Objective: Unknown etiology Background: Electrical storm is a rare but potentially life-threatening syndrome characterized by recurrent ventricular arrhythmias. Liver transplant recipients are at increased risk of developing electrical storms due to conditions that prolong QT intervals, such as cirrhotic cardiomyopathy. However, limited information exists on electrical storms in this specific population. This case report presents a patient who experienced 13 cardiac arrests during ventricular fibrillation following liver transplantation. Case Report: A 61-year-old woman with a medical history of diabetes, obesity, and cirrhosis due to non-alcoholic fatty liver disease underwent liver transplantation using a deceased donor’s liver. Following the procedure, she developed a deterioration in her respiratory function, necessitating orotracheal intubation. Approximately 21 hours post-surgery, she experienced cardiac arrest during ventricular fibrillation, which was rapidly reversed with electrical defibrillation. However, the patient entered a state of electrical storm. Management involved antiar-rhythmic medications and temporary transvenous cardiac pacing. She remained stable for 40 hours, but a dislodgment of the device triggered another episode of ventricular fibrillation, leading to her death. Conclusions: This case report highlights the clinical presentation and challenges in managing electrical storms in liver transplant recipients. We hypothesize that cirrhotic cardiomyopathy could be the cause of her recurrent ventricular arrhythmias. Further studies are needed to better understand the underlying mechanisms and risk factors of this life-threatening syndrome in this population, which may enhance risk stratification and enable earlier intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Life-Threatening Electrical Storm Following Liver Transplantation: A Case Report

Araujo Coelho,

Oliveira da Luz,

Teixeira Basto

et al. 2023

Am J Case Rep

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“…Only amiodarone was associated with hyperthyroidism; however, the incidence did not reach statistical significance. 63 Tables 1-2 47,64 provides a useful guide to antiarrhythmic drug administration for ES. They should not be used to replace clinical judgement when choosing an optimal pharmacological approach for individual patients.…”

Section: Have Spurred the Use Of Catheter Ablation For Es (See Below)mentioning

confidence: 99%

“…Tables 1-2 47,64 provides a useful guide to antiarrhythmic drug administration for ES. They should not be used to replace clinical judgement when choosing an optimal pharmacological approach for individual patients.…”

Section: Introductionmentioning

confidence: 99%

Etiologies, Mechanisms, Management, and Outcomes of Electrical Storm

Trohman

2023

J Intensive Care Med

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Electrical storm (ES) is characterized by three or more discrete sustained ventricular tachyarrhythmia episodes occurring within a limited time frame (generally ≤ 24 h) or an incessant ventricular tachyarrhythmia lasting > 12 h. In patients with an implantable cardioverterdefibrillator (ICD), ES is defined as three or more appropriate device therapies, separated from each other by at least 5 min, which occur within a 24-h period. ES may constitute a medical emergency, depending on the number arrhythmic episodes, their duration, the type, and the cycle length of the ventricular arrhythmias, as well as the underlying ventricular function. This narrative review was facilitated by a search of MEDLINE to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and other clinically relevant studies. The search was limited to English-language reports published between 1999 and 2023. ES was searched using the terms mechanisms, genetics, channelopathies, management, pharmacological therapy, sedation, neuraxial modulation, cardiac sympathetic denervation, ICDs, and structural heart disease. Google and Google scholar as well as bibliographies of identified articles were reviewed for additional references. This manuscript examines the current strategies available to treat ES and compares pharmacological and invasive treatment strategies to diminish ES recurrence, morbidity, and mortality.

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“…Ventricular tachycardia (VT) is defined as a cardiac arrhythmia with three or more consecutive complexes arising from the ventricle at a rate of more than 100 beats per minute [ 1 ]. Ventricular storm is defined as three or more episodes of sustained ventricular tachycardia within a 24-hour period, each requiring termination with chemical or electrical cardioversion [ 2 ]. Management is twofold with acute management and prevention of relapse [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

The Mystery of Electrical Storm: A Case Report

Rahman,

Sohail

2024

Cureus

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Electrical storm is a cardiac emergency, defined as three or more hemodynamically unstable ventricular tachyarrythmias within 24 hours or ventricular tachycardia reoccurring within five minutes. The trigger for an electrical storm can be reversible like drug toxicity and electrolyte imbalances or can be irreversible like structural heart disease. Symptomatic patients can have chest pain, palpitations or syncopal episodes. We present a case of a gentleman in his 60s who was diagnosed with electrical storm which started as an out-of-hospital cardiac arrest. Uniqueness in the case lies in the unknown aetiology after all the investigations came back as normal and management of such cases is based on pacemakers and use of antiarrythmic agents to control and prevent further attacks.

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Emergency Management of Electrical Storm: A Practical Overview

Cited by 4 publications

References 113 publications

Life-Threatening Electrical Storm Following Liver Transplantation: A Case Report

Life-Threatening Electrical Storm Following Liver Transplantation: A Case Report

Etiologies, Mechanisms, Management, and Outcomes of Electrical Storm

The Mystery of Electrical Storm: A Case Report

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