Management of patients with electrical storm: an educational review

Abstract

(1) ES is associated with significant distress, morbidity, and mortality. Patients with ES have high risk for hospitalization, HF decompensation, and in-hospital death. (2) Acute management of ES requires sedation, antiarrhythmic drugs and correction of precipitating factors. In severe refractory cases, intubation, mechanical ventilation, and circulatory support are necessary. (3) Radiofrequency catheter ablation is also frequently required to terminate the ES and to achieve acute and long-term freedom of VT. Catheter ablation is superior than antiarrhythmic drugs to suppress the ES and can be performed as a first-step procedure (4) Optimization of the ICD programming is crucial to spare the anxiety and the distress from further appropriate and inappropriate shocks. Use of appropriate discrimination criteria and algorithms, ATPs and extending the detection times are important measures to reduce the burden of ES (5) In patients with end-stage HF, deactivation of the ICD therapy should be considered and discussed with patients and their caregivers. In suitable patients, heart transplantation or mechanical assist device implantation as a destination therapy may be considered.