Electrical storm is defined as three or more episodes of sustained ventricular arrhythmia occurring within 24 hours, with each event separated by at least 5 minutes, requiring termination by anti-tachycardia pacing or cardioversion/defibrillation.
This protocol addresses the specific situation in which electrical storm arises from sustained monomorphic ventricular tachycardia in a patient with structural heart disease — a high-acuity combination that demands a targeted antiarrhythmic strategy.
The presence of structural heart disease in this setting influences the recommended management pathway. Psychological distress and elevated sympathetic tone are recognised as factors that perpetuate the arrhythmia during electrical storm, and reversible conditions contributing to the arrhythmia should be identified and addressed.
Recommended management includes mild to moderate sedation alongside a combination antiarrhythmic regimen — specifically a non-selective beta-blocker used together with intravenous amiodarone. The full sequence, agent selection rationale, and complete dosing pathway are available in the structured protocol.
Goal: no recurrent sustained ventricular tachycardia
DOI: 10.1093/eurheartj/ehac262
An electrical storm is common in ICD patients and has been defined as three or more episodes of sustained VA occurring within 24 h, requiring either anti-tachycardia pacing (ATP) or cardioversion/defibrillation, with each event separated by at least 5 min.
Antiarrhythmic therapy with beta-blockers (non-selective preferred) in combination with intravenous amiodarone is recommended in patients with SHD and electrical storm unless contraindicated.
Mild to moderate sedation is recommended in patients with electrical storm to alleviate psychological distress and reduce sympathetic tone.
Initial treatment with beta-blockers, preferably non-selective beta-blockers like propranolol, which was superior to metoprolol in one study, combined with amiodarone is most commonly used.
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