Electrical storm: A focused review for the emergency physician

Area of Science:

• Emergency Medicine
• Cardiology

Background:

• Electrical storm is a critical condition requiring immediate attention in the Emergency Department.
• It is characterized by recurrent life-threatening ventricular arrhythmias.

Purpose of the Study:

• To review the diagnosis and management strategies for electrical storm.
• To equip emergency clinicians with current evidence-based approaches.

Main Methods:

• Review of diagnostic criteria for electrical storm (≥3 sustained ventricular tachyarrhythmias/shocks in 24 hours).
• Outline of initial evaluation including ECG, cardiac monitoring, medication review, hemodynamic assessment, and trigger identification.
• Discussion of management principles: antiarrhythmics, beta-blockers, and advanced therapies for refractory cases.

Main Results:

• Patients present with diverse symptoms, necessitating a thorough initial assessment.
• Standard management involves antiarrhythmic and beta-blocker therapy.
• Refractory cases may require advanced interventions like double-sequential defibrillation, IABP, catheter ablation, or ECMO.

Conclusions:

• Electrical storm is associated with high morbidity and mortality.
• Awareness of current evidence is crucial for effective evaluation and management.
• Intensive care unit admission is typically required for these patients.