Recurrent Ventricular Arrhythmia Storms in the Age of Implantable Cardioverter Defibrillator Therapy: A Comprehensive Review

Rapidly recurrent ventricular arrhythmia is not an infrequent clinical entity in the era of implantable cardioverter defibrillator therapy. Clinical presentation can vary dramatically, from multiple defibrillator shocks with hemodynamic instability, to asymptomatic delivery of anti-tachycardia pacing. Although some investigators have reported disparate prognostic implications with electrical storm, in larger trials of both primary and secondary defibrillator populations, electrical storm appears to be a harbinger of cardiac death with a notably high mortality early post event. While acute cessation of electrical storm is generally achievable with medical therapy, it is critical to recognize that the causes for subsequent mortality are often not arrhythmic in nature. Thus, the challenge for cardiovascular practitioners is to maximize substrate based therapy and modification to not only prevent further episodes of electrical storm and possibly curtail the considerable risk of subsequent cardiac mortality.