Ventricular Tachycardia Storm Management in Acute Cardiac Care: Prompt response to life-threatening conditions

Background: Ventricular Tachycardia (VT) storm or electrical storm (ES) is defined as cardiac electrical instability and refers to the occurrence of three or more ventricular tachyarrhythmias (VT and or ventricular fibrillation (VF)) in a 24-hour period, or VT recurring soon (within five minutes) after termination of another VT episode, or sustained or no sustained VT with total ectopic beats greater than sinus beats in a 24-hour period. The frequency of VT storms varies on population. When ICDs are implanted for primary prevention (4 percent), it is lower than when they are implanted for secondary prevention (20 percent). Case Illustration: We presented patient with Ventricular Tachycardia (VT) storm. A 63-year old woman was admitted to emergency room with chief complaint frequent episodes of palpitation. She was found to have monomorphic VT with unstable hemodynamic. Then she got cardioversion 100 Joule, continued with lidocaine drip and VT reverted to sinus rhythm. Patient admitted to intensive cardiovascular care unit, but she had refractory VT. Although she had got complete revascularization for coronary artery before, but the episodic VT still occurred accompanied with cardiogenic shock (CS) and pulmonary edema. She got cardioversion, amiodarone iv and inotropes. She was observed at ICVCU. After the condition stable, she was discharged and planned for ICD insertion at the next admission. Discussion: We discuss the various available treatment options for VT storm and practical challenges faced in management of hemodynamically unstable VT storm. Initial management involves identifying and correcting the underlying ischemia, electrolyte imbalances, or other inciting factors. Conclusion: Unfortunately, after angioplasty or stenting, primary patency is poor. If there is recurring stenosis, the procedure can be repeated.