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World J Cardiol. Sep 26, 2015; 7(9): 555-561
Published online Sep 26, 2015. doi: 10.4330/wjc.v7.i9.555
Electrical storm: A clinical and electrophysiological overview
Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio
Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Corrado Carbucicchio, MD, FESC, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138 Milan, Italy. corrado.carbucicchio@ccfm.it
Telephone: +39-02-58002616 Fax: +39-02-58002782
Received: May 14, 2015
Peer-review started: May 19, 2015
First decision: June 24, 2015
Revised: July 4, 2015
Accepted: July 29, 2015
Article in press: August 3, 2015
Published online: September 26, 2015
Abstract

Electrical storm (ES) is a clinical condition characterized by three or more ventricular arrhythmia episodes leading to appropriate implantable cardioverter-defibrillator (ICD) therapies in a 24 h period. Mostly, arrhythmias responsible of ES are multiple morphologies of monomorphic ventricular tachycardia (VT), but polymorphic VT and ventricular fibrillation can also result in ES. Clinical presentation is very dramatic in most cases, strictly related to the cardiac disease that may worsen electrical and hemodynamic decompensation. Therefore ES management is challenging in the majority of cases and a high mortality is the rule both in the acute and in the long-term phases. Different underlying cardiomyopathies provide significant clues into the mechanism of ES, which can arise in the setting of structural arrhythmogenic cardiomyopathies or rarely in patients with inherited arrhythmic syndrome, impacting on pharmacological treatment, on ICD programming, and on the opportunity to apply strategies of catheter ablation. This latter has become a pivotal form of treatment due to its high efficacy in modifying the arrhythmogenic substrate and in achieving rhythm stability, aiming at reducing recurrences of ventricular arrhythmia and at improving overall survival. In this review, the most relevant epidemiological and clinical aspects of ES, with regard to the acute and long-term follow-up implications, were evaluated, focusing on these novel therapeutic strategies of treatment.

Keywords: Electrical storm, Ventricular tachycardia/fibrillation, Structural heart disease, Antiarrhythmic therapy, Implantable-cardioverter defibrillator, Shock, Catheter ablation

Core tip: Electrical storm is an increasingly common and life-threatening syndrome. The proper management of this arrhythmic emergency is related to a comprehensive assessment of each case. In this review we report all the essential aspects regarding the clinical and diagnostic evaluation, pharmacological treatment and, with special emphasis, catheter ablation approaches.