Complex management of electrical storm in a patient with non-ischemic dilated cardiomyopathy

Abstract

Electrical storm represents a major clinical emergency characterized by electrical heart instability with several recurrent episodes of ventricular arrhythmias over a short period of time. We present the case of a 67-year old male, hypertensive, diabetic who was referred to the cardiology department after a resuscitated cardiac arrest through sustained ventricular tachycardia. The echocardiography revealed a severe aspect of dilated cardiomyopathy and fibrotic aspect of inferior-posterior wall of the left ventricle. The ischemic coronary cause has been ruled out by coronary computed tomography. An implantable cardioverter defibrillator (ICD) was implanted. One day after, the electrical storm and hemodynamically stability worsened requiring high dosage of amiodarone, putting therapies of ICD on “off” and the intubation of the patient. Taking all into account, an urgent electrophysiological study was performed and led to complex radiofrequency catheter ablation of the substrate of the lateral, medium-ventricular wall. Afterwards, the electrical storm did not reappear, the ICD therapies were put on “on” and the patient was rapidly extubated, being discharged with pharmacological recommendations, the milestone being the anti-arrhythmic treatment. Though the treatment of electrical storm is complex but still unclearly defined, we emphasize the need of applying all the therapeutical measures and having a prompt response to this life-threatening condition.