Abstract
Implantable cardioverter defibrillators (ICD) have become indispensable in managing life-threatening ventricular arrhythmias. On average, 50%-70% of the patients receive a device-based therapy within the first two years post implantation. A few patients experience the electrical storm (ES). ES is a syndrome of recurrent ventricular tachycardia or fibrillation occurring two or more times in a 24-hour period, calling for the need of electrical cardioversion or defibrillation to stabilize the patient. We present the case of a patient with severe cardiomyopathy who presented with resistant ES after failing to respond initially to conventional medications like amiodarone and lidocaine. Propofol infusion was not an option due to his severe cardiomyopathy and hypotensive shock state. Aggressive treatment with intravenous medications stabilized his ES and he was eventually transferred to an outside facility for ventricular tachycardia ablation.
Highlights
Studies have shown that 50% to 70% of implantable cardioverter defibrillator (ICD) patients receive appropriate device therapy within the first two years of implantation [1]
We present the case of a patient with severe cardiomyopathy who presented with resistant electrical storm (ES) after failing to respond initially to conventional medications like amiodarone and lidocaine
He had multiple episodes of ventricular tachycardia that was terminated with Implantable cardioverter defibrillators (ICD) firing (Figures 2-3)
Summary
Studies have shown that 50% to 70% of implantable cardioverter defibrillator (ICD) patients receive appropriate device therapy within the first two years of implantation [1]. A male patient with a past medical history of acute myocardial infarction status post coronary stenting, ischemic cardiomyopathy with reduced ejection fraction status post-ICD placement, and dyslipidemia initially presented to our hospital with dizziness, presyncope and two episodes of ICD firing. Initial electrocardiogram (EKG) on admission showed a paced rhythm with frequent premature ventricular contractions (PVCs) (Figure 1) During his hospital stay, he had multiple episodes of ventricular tachycardia that was terminated with ICD firing (Figures 2-3). Another sustained ventricular tachycardia episode followed with subsequent ICD firing and yet another 150 mg intravenous bolus of amiodaron His blood pressure dropped to 60/30 mmHg, deeming the option to sedate the patient with propofol infusion inapplicable.
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