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

Electrical storm is a lethal clinical situation that consists of ventricular tachycardia or ventricular fibrillation attacks, which are usually resistant to pharmacologic or electrical cardioversion. In patients with heart failure; refractory ventricular tachycardia attacks worsen organ perfusion and precipitate acute decompensation, multi-organ failure, and mortality. Extracorporeal membrane oxygenation is very successful for managing periprocedural acute decompensation and it facilitates radiofrequency catheter ablation by adequate mapping and more substrate ablation. Five patients were enrolled whose electrical storm had been treated with either catheter ablation under extracorporeal membrane oxygenation support or other approaches (device setting changes, stellate ganglion blockade, or sympathetic denervation). One patient had a catheter ablation history and was treated with only implantable cardioverter-defibrillator setting changes on this admission. Three of the patients were under veno-arterial extracorporeal membrane oxygenation support, one patient was under left ventricular assist device support. Two patients under extracorporeal membrane oxygenation also needed sympathetic denervation after radiofrequency ablation and stellate ganglion blockade was performed on one of them, before sympathetic denervation. Electrical storms should be managed with multidisciplinary and various treatment approaches. Although radiofrequency catheter ablation is central in treatment, the use of additional modalities including sympathetic denervation may be beneficial. Furthermore, radiofrequency catheter ablation under mechanical support especially with extracorporeal membrane oxygenation may be quite effective, and lifesaving.