Management Of Electrical Storm With Different Treatment Strategies Under Mechanical Support: A Single-Center Case Series

INTRODUCTION: Electrical storm (ES) is a lethal clinical situation that consists of ventricular tachycardia (VT) or ventricular fibrillation (VF) attacks, which is usually resistant to pharmacologic or electrical cardioversion. In patients with heart failure, refractory VT attacks, worsen organ perfusion and precipitate acute decompensation, multi-organ failure, and mortality. Extracorporeal membrane oxygenation (ECMO) is very successful for managing periprocedural acute decompensation and it facilitates RFCA by adequate mapping and more substrate ablation.
METHODS: Five patients were enrolled whose ES had been treated with either RFCA under ECMO support or other approaches (device setting changes, stellate ganglion blockade or sympathetic denervation).
RESULTS: One patient was treated with only ICD setting changes, three of the patients were under VA-ECMO support, one patient was under left ventricular assist device (LVAD) support. Two patients needed also sympathetic denervation after RFCA and stellate ganglion blockade was performed to one of them, before sympathetic denervation.
DISCUSSION AND CONCLUSION: ES should be managed with multidisciplinary and various treatment approaches. Although RFCA is central in treatment, the use of additional modalities including sympathetic denervation may be beneficial. Furthermore, RFCA under mechanical support especially with ECMO may be quite effective, and lifesaving.