STOMPED BY THE STORM : ELECTRICAL STORM IN A PATIENT WITH CARDIAC RESYNCHRONISATION THERAPY DEVICE

Abstract

Introduction : Electrical storm is a potentially fatal occurrence characterized by 3 or more occasions of ventricular arrythmia within 24 hours. 

Case : We describe a case of 52-year old male on cardiac resynchronization therapy device (CRT-D) since 2018 presented with complaints of recurrent firing of CRT-D more than 30 times within the past one hour. He was conscious, although hemodynamically unstable and cardiac monitoring revealed monomorphic ventricular tachycardia recalcitrant to multiple shocks discharged from the CRT-D.

Results : The electrical storms were halted only briefly by repeated external synchronised cadioversions. With the help of antiarrythmic drugs and reprogramming of CRT-D, we were able to stabilize patient.

Discussion : CRT-D use in selected cases improves morbidity and mortality. However, the incidence of electrical storm has become more common. Ischemia and electrolyte imbalance are among the contributing causes of electrical storm in patient with CRT-D.

Conclusion : This case illustrates the challenges faced to suppress the electrical storm in presence of multiple CRTD shocks encountered in a hospital setting without cardiology service.