Electrical storm

Background

• Definition
  • 3 or more episodes of sustained VT, VF, or ICD shocks within 24 hours
• Risk factors
  • CAD
  • HFrEF
  • Long QT
  • DM2 is protective
• Causes
  • Ischemia
  • Electrolyte derangement
  • Iatrogenic (i.e. QT prolonging medications)
  • Hyperthyroidism
  • Infection/Fever

Clinical Features

• Presentation as:
  • Cardiac arrest
  • Palpitations
  • (Pre)Syncope
  • ICD patient complaining of shock(s)

Differential Diagnosis

• Tachycardia (wide)
• ICD malfunction
  • AF/SVT
  • Oversensing
  • Lead fracture

Management

Proposed treatment algorithm for electrical storm

Disposition

• CCU or cath lab

See Also

• Torsades de pointes
• Tachycardia (Wide)
• Adult pulseless arrest