Abstract
A 48-year-old previously healthy woman suffered witnessed cardiac arrest in hospital. She achieved return of spontaneous circulation and was transferred to the intensive care unit. During the following 3 hours, she suffered a cardiac electrical storm with 98 episodes of Torsade de Pointes ventricular tachycardia rapidly degenerating to ventricular fibrillation. She was converted with a total of 99 defibrillations. There was no response to the use of any recommended anti arrhythmic drugs. However, the use of bretylium surprisingly stabilized her heart rhythm and facilitated placing of a temporary pacemaker. Overdrive pacing prevented further arrhythmias and was life saving. A number of beneficial factors may have contributed to the good neurological outcome. Further investigations gave no explanation for her cardiac electrical storm.
Highlights
Torsade de Pointes (TdP) cardiac electrical storm may be defined as the occurrence of more than two distinct episodes of destabilizing TdP in 24 hours [1,2]
In this report we describe a case were a previously healthy woman suffered a dramatic period of multiple events with TdP degenerating to Ventricular Fibrillation (VF)
Defibrillation of VF to SR Intubation Transport to Intensive Care Unit (ICU), sedation is discontinued Monitoring, arterial and central venous lines established Lack of normal awakening Initiation of therapeutic hypothermia First of subsequent 98 episodes of TdP degenerating to VF Hypothermic infusion is discontinued Multiple efforts to stabilize rhythm including recommended anti-arrhythmic drugs Increasing frequency of TdP is noticed Bretylium 10 ml administered (95 defibrillations have been given) Start of a 20 min period with stable sinus rhythm, transport to cardiac laboratory Placing of temporary ventricular pacing lead is finished Overdrive pacing is initiated, another three events of TdP degenerating to VF are handled Effective overdrive pacing is achieved and circulation is stable suffered a new event of ventricular arrhythmia
Summary
Torsade de Pointes (TdP) cardiac electrical storm may be defined as the occurrence of more than two distinct episodes of destabilizing TdP in 24 hours [1,2]. Defibrillation of VF to SR Intubation (fentanyl and midazolam as sedative agents) Transport to ICU, sedation is discontinued Monitoring, arterial and central venous lines established Lack of normal awakening Initiation of therapeutic hypothermia First of subsequent 98 episodes of TdP degenerating to VF Hypothermic infusion is discontinued Multiple efforts to stabilize rhythm including recommended anti-arrhythmic drugs Increasing frequency of TdP is noticed Bretylium 10 ml administered (95 defibrillations have been given) Start of a 20 min period with stable sinus rhythm, transport to cardiac laboratory Placing of temporary ventricular pacing lead is finished Overdrive pacing is initiated, another three events of TdP degenerating to VF are handled Effective overdrive pacing is achieved and circulation is stable. She has continued long-term treatment with metoprolol succinate and has returned to fulltime work
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