Electrical storm caused by sertraline overdose: case report

In cases of electrical storm, identifying the etiology is essential, as patients with reversible causes do not benefit from implantable cardioverter defibrillator (ICD). Given the diversity of pharmacologic and nonpharmacologic management tools available for hemodynamically unstable patients in electrical storm, all must be considered and tailored to each individual patient.

This report describes a 36-year-old female without prior cardiac history who presented in ventricular fibrillation (VF) electrical storm. While she lacked significant electrolyte abnormalities or ischemia to explain etiology of electrical storm, she incidentally had variant coronary anatomy noted on angiography. After thorough consideration of possible etiologies of storm, selective serotonin reuptake inhibitor (SSRI) intoxication was the most highly suspected etiology. Regarding management of her hemodynamically unstable electrical storm, she was treated with lidocaine, amiodarone, as well as mechanical circulatory support devices including extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump (IABP). The patient ultimately was decannulated from ECMO, had IABP removal, and achieved recovery of ejection fraction (EF) to baseline. She was not offered ICD as the etiology of her cardiac arrest was reversable. She was discharged with recommendation to discontinue SSRI and follow up with psychiatry regarding SSRI overdose.

Identification of electrical storm etiology is crucial as reversible causes do not warrant ICD placement. Selection of appropriate pharmacologic and nonpharmacologic management in the hemodynamically unstable electrical storm patient is important given the wide range of available options.