The lack of evidence-based management in electrical storm: a scoping review

Electrical storm (ES) is associated with a significant risk of morbidity and mortality. Despite this, there has been limited research in ES resulting in uncertainty and inconsistency in the management of this life-threatening condition. The objective of this scoping review was to define the current body of literature evaluating pharmacologic and non-pharmacologic therapies used in the management of ES. A comprehensive search of Medline, CENTRAL and Embase was completed on January 11, 2025. Primary studies on pharmacotherapies in ES were included if they reported therapy-related outcomes and included ≥ 5 adult patients. A total of 45 studies met the inclusion criteria. Four studies were randomized control trials (three trials had overlapping cohorts) and the remaining were observational studies. Amiodarone, quinidine, landiolol, isoproterenol, and mexiletine were the most studied medications. The use of sedation for ES was exclusively studied in the context of mechanical ventilation. There was an increase in the number of ES studies over time, but sample sizes remained small and unchanged. Existing evidence to guide the management of ES is predominantly based on small observational studies. High quality data to inform the management of ES is needed.