Refractory electrical cardiac storm during twin pregnancy delivery: A multidisciplinary clinical challenge

Electrical storm (ES) is a rare and life-threatening cardiac emergency characterized by recurrent ventricular arrhythmias, posing unique challenges when it occurs during pregnancy. We report the case of a 28-year-old woman presenting with refractory ES in the late stages of a dichorionic-diamniotic twin pregnancy. Initial management included emergent cesarean delivery under general anesthesia due to maternal hemodynamic instability and fetal bradycardia. Despite pharmacological stabilization and multiple synchronized cardioversions, the arrhythmia persisted, necessitating catheter ablation to restore sinus rhythm. Multidisciplinary collaboration involving anesthesiology, obstetrics, cardiology, and electrophysiology ensured a favorable outcome for both mother and neonates, with no long-term complications. This case highlights the critical importance of tailored, interdisciplinary approaches in managing ES during pregnancy and underscores the need for resource optimization and rapid decision-making to balance maternal and fetal safety. Future investigations should focus on identifying potential triggers and improving protocols for the management of ES in high-risk pregnancies.