Management of Ventricular Electrical Storm: A Contemporary Appraisal

Gurukripa N. Kowlgi; Yong-Mei Cha


Europace. 2020;22(12):1768-1780. 

In This Article


Ventricular electrical storm is incompletely understood from large trials studying ventricular tachycardia (VT) ablation. This is because patients with VES either form a small proportion of enrollees or are excluded from most of the prominent VT studies.[11] Furthermore, depending on the defining criteria, the incidence may vary among different reports. Male sex, advanced age, lower left ventricular (LV) ejection fraction, and the presence of medical comorbidities increase the susceptibility of developing VES.[11] Ventricular electrical storm prevalence in ischaemic cardiomyopathy (ICM) and non-ischaemic dilated cardiomyopathy (NICM) is roughly estimated to be comparable with high recurrence rates in both subsets.[8,11,12] Studies have shown that 10–28% of the patients with secondary prevention ICDs can sustain VES[3,13,14] with over a three-fold increase in mortality as compared to controls.[8] Monomorphic VT as a triggering arrhythmia, was found to have a higher association with VES as compared to polymorphic VT and ventricular fibrillation (VF).[8,15] (Supplementary material online, Table S1) summarizes the clinical trials of VES. The mean frequency of VES was 2–55 episodes. Prior treatment with Vaughan Williams class I antiarrhythmic drugs is associated with a higher incidence of VES.[8,11]