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Electrical Storm — EECC MCQ

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ModerateArrhythmia & ElectrophysiologyElectrical StormEECC

A 68-year-old man with an ICD for ischaemic cardiomyopathy receives 5 ICD shocks within 24 hours for confirmed monomorphic VT. He is haemodynamically stable after each episode. IV amiodarone has been commenced. What defines this clinical scenario?

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Correct answer: D — Electrical storm — defined as ≥3 sustained VT/VF episodes or appropriate ICD therapies within 24 hours

Electrical storm is defined as ≥3 episodes of sustained VT, VF, or appropriate ICD therapies (ATP or shocks) within 24 hours. This is a medical emergency requiring intensive management. The 2022 ESC VA/SCD Guidelines recommend: (1) IV amiodarone as first-line (300 mg bolus then 900-1200 mg/24h infusion); (2) IV beta-blocker (esmolol or propranolol); (3) deep sedation or intubation if refractory; (4) urgent catheter ablation referral for recurrent monomorphic VT; (5) correction of precipitants (electrolytes, ischaemia, medications). Stellate ganglion block or thoracic epidural may be considered for refractory cases.

Reference: ESC (2022): Guidelines on Ventricular Arrhythmias and Prevention of Sudden Cardiac Death