Electrical storm - Revision history

Danbot: Add MedicationDose entries for amiodarone, lidocaine, esmolol, propranolol, magnesium, isoproterenol

2026-03-20T21:01:47Z

Add MedicationDose entries for amiodarone, lidocaine, esmolol, propranolol, magnesium, isoproterenol

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 *IABP / [[ECMO]]
 *[[Palliative care]] as this could represent impending terminal failure
 ==Disposition==

2021-07-02T00:48:49Z

External Links

← Older revision		Revision as of 00:48, 2 July 2021
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	==External Links==		==External Links==
			*[https://first10em.com/electrical-storm/ First10EM - Management of Electrical Storm]
			*[https://emottawablog.com/2020/05/braving-the-electrical-storm-in-the-ed/ EM Ottawa - Braving the Electrical Storm in the ED]

	==References==		==References==

2020-05-12T20:53:32Z

Emergency Department

← Older revision		Revision as of 20:53, 12 May 2020
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	***[[Isoproterenol]] infusion is 1st line		***[[Isoproterenol]] infusion is 1st line
	***[[Quinidine]] may be of benefit<ref>Belhassen B et al. Efficacy of Quinidine in High-Risk Patients With Brugada Syndrome. Circulation. 2004; 110: 1731-1737.</ref>		***[[Quinidine]] may be of benefit<ref>Belhassen B et al. Efficacy of Quinidine in High-Risk Patients With Brugada Syndrome. Circulation. 2004; 110: 1731-1737.</ref>
	****Due to ~~it's~~ Ito channel blockade		****Due to its Ito channel blockade
	****Sodium channel blockade may be harmful, however (avoid other Class I antiarrhythmics)		****Sodium channel blockade may be harmful, however (avoid other Class I antiarrhythmics)
	*Consider [[isoproterenol]] in electrical storm in the following situations:		*Consider [[isoproterenol]] in electrical storm in the following situations:

2020-05-12T20:51:02Z

Clinical Features

← Older revision		Revision as of 20:51, 12 May 2020
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	**(Pre)[[Syncope]]		**(Pre)[[Syncope]]
	**ICD patient complaining of shock(s)		**ICD patient complaining of shock(s)

			*Type of Ventricular Arrhythmias <ref>Credner SC, Klingenheben T, Mauss O, et al. Electrical storm in patients with transvenous implantable cardioverter-defibrillators: incidence, management and prognostic implications. J Am Coll Cardiol 1998; 32:1909</ref> <ref>Hohnloser SH, Al-Khalidi HR, Pratt CM, et al. Electrical storm in patients with an implantable defibrillator: incidence, features, and preventive therapy: insights from a randomized trial. Eur Heart J 2006; 27:3027</ref>
			**Monomorphic VT 86-97%
			**Primary VF 1-21%
			**Mixed VT/VF 3-14%
			**Polymorphic VT 2-8%

	==Differential Diagnosis==		==Differential Diagnosis==

2020-05-12T20:34:16Z

Background

← Older revision		Revision as of 20:34, 12 May 2020
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	==Background==		==Background==
	*Definition: 3 or more episodes of sustained [[ventricular tachycardia]], [[ventricular fibrilation]], or ICD shocks within 24 hours		*Definition: 3 or more episodes of sustained [[ventricular tachycardia]], [[ventricular fibrilation]], or ICD shocks within 24 hours
	*Most have underlying structural heart disease, but also seen in those with structurally normal hearts (i.e. Brugada syndrome, Long QT syndrome)		*Most have underlying structural heart disease, but also seen in those with structurally normal hearts (i.e. [[Brugada syndrome]], [[Long QT syndrome]])
	*Type 2 Diabetes is protective		*Type 2 Diabetes is protective

2020-05-12T20:33:26Z

Background

← Older revision		Revision as of 20:33, 12 May 2020
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	==Background==		==Background==
	*Definition: 3 or more episodes of sustained [[ventricular tachycardia]], [[ventricular fibrilation]], or ICD shocks within 24 hours		*Definition: 3 or more episodes of sustained [[ventricular tachycardia]], [[ventricular fibrilation]], or ICD shocks within 24 hours
			*Most have underlying structural heart disease, but also seen in those with structurally normal hearts (i.e. Brugada syndrome, Long QT syndrome)
	*Type 2 Diabetes is protective		*Type 2 Diabetes is protective

2019-10-02T22:40:46Z

Inpatient

← Older revision		Revision as of 22:40, 2 October 2019
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	*Ablation		*Ablation
	*Left sympathetic ganglionic blockade		*Left sympathetic ganglionic blockade
	*Deep sedation / general anesthesia		*Deep [[sedation]] / general anesthesia
	*IABP / ECMO		*IABP / [[ECMO]]
	*Palliative care as this could represent impending terminal failure		*[[Palliative care]] as this could represent impending terminal failure

	==Disposition==		==Disposition==

2019-09-27T05:22:32Z

← Older revision		Revision as of 05:22, 27 September 2019
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	==Background==		==Background==
	*Definition		*Definition: 3 or more episodes of sustained [[ventricular tachycardia]], [[ventricular fibrilation]], or ICD shocks within 24 hours
	**3 or more episodes of sustained [[ventricular tachycardia]], [[ventricular fibrilation]], or ICD shocks within 24 hours		*Type 2 Diabetes is protective

	===Risk factors <ref> Brigadeau F et al. Clinical predictors and prognostic significance of electrical storm in patients with implantable cardioverter defibrillators. Eur Heart J 2006;27:700-7. </ref>===		===Risk factors <ref> Brigadeau F et al. Clinical predictors and prognostic significance of electrical storm in patients with implantable cardioverter defibrillators. Eur Heart J 2006;27:700-7. </ref>===
	*CAD		*CAD
	*HFrEF		*HFrEF
	*[[~~Long~~ QT]]		*[[QT prolongation]]
	*DM2 is protective

	===Causes===		===Causes===
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	==Management==		==Management==



	===Emergency Department===		===Emergency Department===
	*Follow current ACLS guidelines if pulseless		*Follow current ACLS guidelines if pulseless
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	==Disposition==		==Disposition==
	*~~CCU or cath lab~~		*Admit

	==See Also==		==See Also==
	*[[Torsades de pointes]]		*[[Torsades de pointes]]
	*[[~~Tachycardia (~~Wide)]]		*[[Wide-complex tachycardia]]
	*[[Adult pulseless arrest]]		*[[Adult pulseless arrest]]

	==External Links==		==External Links==


	==References==		==References==

2019-09-24T17:30:23Z

Emergency Department

← Older revision		Revision as of 17:30, 24 September 2019
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	*Follow current ACLS guidelines if pulseless		*Follow current ACLS guidelines if pulseless
	**See [[Adult Pulseless Arrest]]		**See [[Adult Pulseless Arrest]]
	*Analgesia / ~~Sedation~~ for all patients		*[[Analgesia]] / [[sedation]] for all patients
	*ACC recommends repletion of K to 4.5 in all cases <ref name="ACC SCD"> Zipes DP et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. J Am Coll Card 2006;48(5):e247-346. </ref>		*ACC recommends repletion of K to 4.5 in all cases <ref name="ACC SCD"> Zipes DP et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. J Am Coll Card 2006;48(5):e247-346. </ref>

2018-08-11T18:22:25Z

Management

← Older revision		Revision as of 18:22, 11 August 2018
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	**[[Metoprolol]] 2.5-5mg IV q2-5 min to max of 15mg		**[[Metoprolol]] 2.5-5mg IV q2-5 min to max of 15mg
	**[[Propranolol]] 0.15mg/kg IV over 10 minutes followed by 3-5mg q6h; may be effective even if metoprolol fails		**[[Propranolol]] 0.15mg/kg IV over 10 minutes followed by 3-5mg q6h; may be effective even if metoprolol fails
			***More efficacious than metoprolol, terminated VT at 3 hours vs. 18 hours with metoprolol <ref> Chatzidou, S., Kontogiannis, C., Tsilimigras, D. I., Georgiopoulos, G., Kosmopoulos, M., Papadopoulou, E., … Rokas, S. (2018). Propranolol Versus Metoprolol for Treatment of Electrical Storm in Patients With Implantable Cardioverter-Defibrillator. Journal of the American College of Cardiology, 71(17), 1897–1906.</ref>
	**[[Esmolol]] 300-500 mcg/kg load over 1 minutes follwed by infusion at 25-50 mcg/kg/min initial dose		**[[Esmolol]] 300-500 mcg/kg load over 1 minutes follwed by infusion at 25-50 mcg/kg/min initial dose