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World J Cardiol. Jun 26, 2017; 9(6): 521-530
Published online Jun 26, 2017. doi: 10.4330/wjc.v9.i6.521
Management of ventricular tachycardia storm in patients with structural heart disease
Daniele Muser, Pasquale Santangeli, Jackson J Liang
Daniele Muser, Pasquale Santangeli, Jackson J Liang, Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, United States
Author contributions: Muser D, Santangeli P and Liang JJ contributed significantly to the writing and revision process of this manuscript.
Conflict-of-interest statement: The authors report no relevant conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jackson J Liang, DO, Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, United States. jackson.liang@uphs.upenn.edu
Telephone: +1-215-6626005 Fax: +1-215-6622879
Received: February 16, 2017
Peer-review started: February 17, 2017
First decision: April 14, 2017
Revised: May 1, 2017
Accepted: May 12, 2017
Article in press: May 15, 2017
Published online: June 26, 2017
Processing time: 129 Days and 22 Hours
Abstract

Electrical storm (ES) is a medical emergency characterized by repetitive episodes of sustained ventricular arrhythmias (VAs) in a limited amount of time (at least 3 within a 24-h period) leading to repeated appropriate implantable cardioverter defibrillator therapies. The occurrence of ES represents a major turning point in the natural history of patients with structural heart disease being associated with poor short- and long-term survival particularly in those with compromised left ventricular ejection fraction (LVEF) that can develop hemodynamic decompensation and multi-organ failure. Management of ES is challenging with limited available evidence coming from small retrospective series and a substantial lack of randomized-controlled trials. In general, a multidisciplinary approach including medical therapies such as anti-arrhythmic drugs, sedation, as well as interventional approaches like catheter ablation, may be required. Accurate patient risk stratification at admission for ES is pivotal and should take into account hemodynamic tolerability of VAs as well as comorbidities like low LVEF, advanced NYHA class and chronic pulmonary disease. In high risk patients, prophylactic mechanical circulatory support with left ventricular assistance devices or extracorporeal membrane oxygenation should be considered as bridge to ablation and recovery. In the present manuscript we review the available strategies for management of ES and the evidence supporting them.

Keywords: Electrical storm; Ventricular tachycardia; Catheter ablation; Mechanical hemodynamic support; Anti-arrhythmic drugs

Core tip: Electrical storm (ES) is a life-threatening condition characterized by ongoing ventricular arrhythmias leading to appropriate implantable cardioverter defibrillator therapies. It is associated with increased mortality and requires urgent medical care. In this review, we summarize the prognostic implications for ES as well as available treatment strategies to manage ES.