A patient with an implantable cardioverter-defibrillator (ICD) may develop an "electric storm", a term referring to multiple discharges of the ICD during a short period of time. Repeated discharges of an ICD may affect the patient's quality of life.


Criteria for an electrical storm:

(1) presence of >= 3 distinct (separated by 5 or more minutes ) episodes of sustained ventricular tachycardia and/or ventricular fibrillation

(2) within a 24 hour period


Risk factors of Arya et al for electrical storm (odds ratios from 4 to 6):

(1) width of QRS complex >= 120 milliseconds

(2) left ventricular ejection fraction < 25%.

(3) absence of beta-blocker therapy

(4) absence of ACE inhibitor therapy


The occurrence of electrical storm is an independent predictor of death (Exner et al, 2001; Verma et al, 2004).


Management may include one or more of the following (Gehi et al, 2006):

(1) Treatment of potentially reversible triggers (electrolyte imbalance, myocardial ischemia, medications that prolong the QRS interval).

(2) Administration of amiodarone or other antiarrhythmic agent, usually with beta-adrenergic blockade.

(3) Sedation with propofol.

(4) Overdrive pacing.

(5) Emergent catheter ablation (if all else fails)


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