Orage rythmique secondaire à une hypokaliémie chez un patient porteur d'un défibrillateur automatique implantable

Electrical storm in patients with implantable cardioverter defibrillator (ICDs) is a rhythmic emergency which can be immediately lethal. It occurs especially in patients with an advanced cadiomyopathy. Such arrhythmias predictor factors and triggers are rarely found. We report the case of a 73-year-old man with ischemic dilated cadiomyopathy, who underwent a complete surgical revascularisation six years ago. In 2003, this patient was hospitalised in cardiology because of a sustained ventricular tachycardia reduced by electrical shock. Because of the aggravation of the heart failure with a NYHA functional class III, electrical and echocardiographic criteria of ventricular dyssynchrony, a biventricular ICD was implanted. Three years after, the patient was hospitalized because of an electrical storm with 96 appropriate shocks. A severe hypokaliemia was the cause of this electrical storm, and the evolution was favourable after correction of the hypokaliemia. Hypokaliemia is rarely the trigger of such arrhythmias, it represent only 3 % of the causes. Its prevalence may be underestimated especially in patients with heart failure who receive high doses of diuretics.