Table 2:

ESC Guideline recommendations for electrical storm.²

Class I recommendations

Mild to moderate sedation is recommended in patients with electrical storm to alleviate psychological distress and reduce sympathetic tone (LOE: C)

Antiarrhythmic therapy with beta-blockers (non-selective preferred) in combination with intravenous amiodarone is recommended in patients with structural heart disease and electrical storm unless contraindicated (LOE: B)

Intravenous magnesium with supplementation of potassium is recommended in patients with TdP (LOE: C)

Isoproterenol or transvenous pacing to increase heart rate is recommended in patients with acquired long QT syndrome and recurrent TdP despite correction of precipitating conditions and magnesium (LOE: C)

Catheter ablation is recommended in patients presenting with incessant VT or electrical storm due to MMVT refractory to AADs (LOE: B)

Class IIa recommendations

Deep sedation/intubation should be considered in patients with an intractable electrical storm refractory to drug treatment (LOE: C)

Catheter ablation should be considered in patients with recurrent episodes of PMVT/VF triggered by a similar PVC, non-responsive to medical treatment or coronary revascularization (LOE: C)

Class IIb recommendations

Quinidine may be considered in patients with CAD and electrical storm due to recurrent PMVT when other AAD therapy fails (LOE: C)

Autonomic modulation may be considered in patients with electrical storm refractory to drug treatment and in whom catheter ablation is ineffective or not possible (LOE: C)

Institution of mechanical circulatory support may be considered in the management of drug-refractory electrical storm and cardiogenic shock (LOE: C)

Abbreviations: AAD, antiarrhythmic drug; CAD, coronary artery disease; LOE, level of evidence; MMVT, monomorphic ventricular tachycardia; PMVT, polymorphic ventricular tachycardia; PVC, premature ventricular contraction; TdP, torsades des pointes; VF, ventricular fibrillation; VT, ventricular tachycardia.