Electrical Storm of the Heart: A Shocking Experience!

  • Patrick Sylvester
  • Christopher E. San MiguelEmail author


For emergency physicians, the diagnosis, treatment, and management of unstable ventricular dysrhythmias are rather simple. These patients are dead or dying. They fall quite neatly into the advanced cardic life support (ACLS) algorithms which are firmly engrained in our resuscitative minds. However, those patients who are “stable-ish” are at risk for devolving into electrical anarchy and may continue to require repeated therapies (electrical or pharmacologic) for their symptomatic ventricular dysrhythmias. This patient population can be challenging to manage.


Emergency physicians The diagnosis Treatment Management Unstable ventricular dysrhythmias 


Disclosure Statement

The authors of this chapter report no significant disclosures.


  1. 1.
    Sagone A. Electrical storm: incidence, prognosis and therapy. J Atr Fibrillation. 2015;8(4):1150.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Israel CW, Barold SS. Electrical storm in patients with an implanted defibrillator: a matter of definition. Ann Noninvasive Electrocardiol. 2007;12(4):375–82.CrossRefGoogle Scholar
  3. 3.
    Al-khatib SM, Stevenson WG, Ackerman MJ, et al. AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2017:2017.Google Scholar
  4. 4.
    Ueno A, Kobayashi Y, Murata H, et al. The short-term prognosis of the patients with ventricular tachycardia and fibrillation: from the registry data of Tokyo CCU Network for 3 years. The proceedings of the 37th scientific meeting of Tokyo CCU Network. ICU and CCU. 2018 (In press).Google Scholar
  5. 5.
    Eifling M, Razavi M, Massumi A. The evaluation and management of electrical storm. Tex Heart Inst J. 2011;38:111–21.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Burns B. VT versus SVT LITFL Medical Blog ECG library basics. In: Life in the fast lane.; 2019. Accessed 4 Mar 2019.
  7. 7.
    Dorian P, Cass D, Schwartz B, Cooper R, Gelaznikas R, Barr A. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med. 2002;346(12):884–90.CrossRefGoogle Scholar
  8. 8.
    Muser D, Santangeli P, Liang JJ. Management of ventricular tachycardia storm in patients with structural heart disease. World J Cardiol. 2017;9(6):521–30.CrossRefGoogle Scholar
  9. 9.
    Panchal AR, Berg KM, Kudenchuk PJ, et al. 2018 American Heart Association Focused Update on Advanced Cardiovascular Life Support Use of Antiarrhythmic Drugs During and Immediately After Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2018;138(23):e740–9.CrossRefGoogle Scholar
  10. 10.
    Dorian P, Cass D, Schwartz B, Cooper R, Gelaznikas R, Barr A. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med. 2002;346(12):884–90.CrossRefGoogle Scholar
  11. 11.
    Chatzidou S, Kontogiannis C, Tsilimigras DI, et al. Propranolol versus metoprolol for treatment of electrical storm in patients with implantable cardioverter-defibrillator. J Am Coll Cardiol. 2018;71(17):1897–906.CrossRefGoogle Scholar
  12. 12.
    Burjorjee JE, Milne B. Propofol for electrical storm; a case report of cardioversion and suppression of ventricular tachycardia by propofol. Can J Anaesth. 2002;49(9):973–7.CrossRefGoogle Scholar
  13. 13.
    Grubb BP, Temesy-Armos P, Hahn H, Elliott L. The use of external, noninvasive pacing for the termination of ventricular tachycardia in the emergency department setting. Ann Emerg Med. 1992;21(2):174–6.CrossRefGoogle Scholar
  14. 14.
    Kobayashi Y. How to manage various arrhythmias and sudden cardiac death in the cardiovascular intensive care. J Intensive Care. 2018;6:23.CrossRefGoogle Scholar
  15. 15.
    Nademanee K, Taylor R, Bailey WE, Rieders DE, Kosar EM. Treating electrical storm: sympathetic blockade versus advanced cardiac life support-guided therapy. Circulation. 2000;102(7):742–7.CrossRefGoogle Scholar
  16. 16.
    Liang JJ, Santangeli P, Callans DJ. Long-term outcomes of ventricular tachycardia ablation in different types of structural heart disease. Arrhythmia Electrophysiol Rev. 2015;4(3):177–83.CrossRefGoogle Scholar
  17. 17.
    Anter E, Hutchinson MD, Deo R, et al. Surgical ablation of refractory ventricular tachycardia in patients with nonischemic cardiomyopathy. Circ Arrhythm Electrophysiol. 2011;4(4):494–500.CrossRefGoogle Scholar
  18. 18.
    Zhang ZP, Su X, Yan H, et al. Reversal of electrical storm after intraaortic balloon pump counterpulsation in a patient with acute myocardial infarction. Am J Emerg Med. 2015;33(5):734.e1–3.CrossRefGoogle Scholar
  19. 19.
    Uribarri A, Bravo L, Jimenez-candil J, Martin-moreiras J, Villacorta E, Sanchez PL. Percutaneous extracorporeal membrane oxygenation in electrical storm: five case reports addressing efficacy, transferring allowance or radiofrequency ablation support. Eur Heart J Acute Cardiovasc Care. 2017:2048872617730036.Google Scholar
  20. 20.
    Cortez E, Krebs W, Davis J, Keseg DP, Panchal AR. Use of double sequential external defibrillation for refractory ventricular fibrillation during out-of-hospital cardiac arrest. Resuscitation. 2016;108:82–6.CrossRefGoogle Scholar
  21. 21.
    Delorenzo A, Nehme Z, Yates J, Bernard S, Smith K. Double sequential external defibrillation for refractory ventricular fibrillation out-of-hospital cardiac arrest: a systematic review and meta-analysis. Resuscitation. 2019;135:124–9.CrossRefGoogle Scholar
  22. 22.
    D Gerstein NS, Mclean AR, Stecker EC, Schulman PM. External defibrillator damage associated with attempted synchronized dual-dose cardioversion. Ann Emerg Med. 2018;71:109–12.CrossRefGoogle Scholar
  23. 23.
    Lee YH, Lee KJ, Min YH, et al. Refractory ventricular fibrillation treated with esmolol. Resuscitation. 2016;107:150–5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Emergency Medicine, Wexner Medical Center at The Ohio State UniversityColumbusUSA

Personalised recommendations