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Case Report
 
Electrical storm: Is right ventricular pacing dangerous?
Daniel Mark Cooper1, Kathleen M. Kennedy2
1MD, FACC, Assistant Professor of Cardiology and Medicine, Department of Clinical Sciences Florida State University College of Medicine, Sarasota, Florida, USA, Past Director, Electrophysiology Catheterization Laboratory, Sarasota Memorial Hospital.
2MD Clinical Professor of Medicine, Department of Clinical Sciences, Florida State University College of Medicine, Sarasota, Florida, USA.

Article ID: Z01201703CR10772DC
doi:10.5348/ijcri-201733-CR-10772

Address correspondence to:
Daniel M. Cooper
MD, FACC 1875 Floyd St
Sarasota, Florida
USA 34239

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How to cite this article
Cooper DM, Kennedy KM. Electrical storm: Is right ventricular pacing dangerous? Int J Case Rep Images 2017;8(3):191–195.


Abstract
Introduction: Electrical storm is commonly defined as the occurrence of three or more episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF) in 24 hours. Patients with an implantable cardiac defibrillator (ICD) are at increased risk of electrical storm due to history of decreased ejection fraction and/or sustained VT/VF. In addition to medical treatment of electrical storm in ICD patients, special consideration should be given to ICD reprogramming to optimize hemodynamics by increasing basic pacing rate and maintaining atrioventricular as well as interventricular synchrony. If possible, anti-tachycardia pacing rather than repeated shocks can reduce sympathetic tone. Unnecessary right ventricular pacing may worsen left ventricular function by desynchronizing the ventricles and is generally avoided.
Case Report: We present a case of a 67-year-old white male with severe electrical storm due to polymorphic ventricular tachycardia (PMVT) that was dramatically brought under immediate control by forced right ventricular pacing. Subsequent continuous right ventricular pacing helped suppress any ventricular tachycardia recurrence until catheter ablation was performed eight months later.
Conclusion: When confronted with patients with refractory electrical storm, we propose programming a faster right ventricular pacing rate.

Keywords: Electrical storm, Implantable cardiac defibrillator, Polymorphic ventricular tachycardia, Right ventricular pacing, Ventricular desynchronization


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Author Contributions
Daniel M. Cooper – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Kathleen M. Kennedy – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2017 Daniel M. Cooper et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.