Multidisciplinary Critical Care Management of Electrical Storm: JACC State-of-the-Art Review

American College of Cardiology Critical Care Cardiology and Electrophysiology Sections, Jacob C. Jentzer, Peter A. Noseworthy, Anthony H. Kashou, Adam M. May, Jonathan Chrispin, Rajesh Kabra, Kelly Arps, Vanessa Blumer, James E. Tisdale, Michael A. Solomon

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations

Abstract

Electrical storm (ES) reflects life-threatening cardiac electrical instability with 3 or more ventricular arrhythmia episodes within 24 hours. Identification of underlying arrhythmogenic cardiac substrate and reversible triggers is essential, as is interrogation and programming of an implantable cardioverter-defibrillator, if present. Medical management includes antiarrhythmic drugs, beta-adrenergic blockade, sedation, and hemodynamic support. The initial intensity of these interventions should be matched to the severity of ES using a stepped-care algorithm involving escalating treatments for higher-risk presentations or recurrent ventricular arrhythmias. Many patients with ES are considered for catheter ablation, which may require the use of temporary mechanical circulatory support. Outcomes after ES are poor, including frequent ES recurrences and deaths caused by progressive heart failure and other cardiac causes. A multidisciplinary collaborative approach to the management of ES is crucial, and evaluation for heart transplantation or palliative care is often appropriate, even for patients who survive the initial episode.

Original languageEnglish
Pages (from-to)2189-2206
Number of pages18
JournalJournal of the American College of Cardiology
Volume81
Issue number22
DOIs
StatePublished - Jun 6 2023

Keywords

  • cardiomyopathy
  • heart failure
  • implantable cardioverter-defibrillator
  • myocardial infarction
  • shock
  • sudden cardiac death
  • ventricular fibrillation
  • ventricular tachycardia

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