Idiopathic Cardiac Electrical Storm

Cardiac electrical storm has been described as three or more distinct episodes of ventricular fibrillation or hemodynamically destabilizing ventricular tachycardia in a 24-h period, typically requiring treatment with electrical cardioversion or defibrillation. We report the case of a 45-year-old man who presented to the Emergency Department with idiopathic cardiac electrical storm, ultimately requiring defibrillation over 30 times in the Emergency Department and infusion of multiple antidysrhythmic agents for dysrhythmia control. Treatment of cardiac electrical storm entails immediate resuscitative therapy during the hemodynamically destabilizing episode (including cardioversion/defibrillation and the timely administration of antidysrhythmic agents), concurrent identification and correction of any factors that are potentially contributing to the acute dysrhythmia (i.e., electrolyte disturbances, myocardial ischemia), and ultimately, institution of long-term preventive therapy (such as an implantable cardioverter defibrillator) to quell recurrence. Amiodarone and beta-adrenergic blockers seem to be the agents of greatest clinical benefit to patients with cardiac electrical storm. Despite its potentially devastating nature, the majority of patients with cardiac electrical storm may have favorable clinical outcomes if the dysrhythmias are treated swiftly and aggressively.