I'd like to share with you a patient presentation that I encountered during an emergency department (ED) shift just yesterday. A 58-year-old man with a history of severe cardiomyopathy, ejection fraction of 15%, and an internal cardioverter-defibrillator (ICD) presented to the ED reporting at least five episodes of his ICD firing during the prior few hours. Shortly after his arrival, his ICD fired once again, and the telemetry monitor demonstrated a run of monomorphic ventricular tachycardia (VT) leading to the shock. The patient was obviously suffering from the pain as well as the emotional distress of the repeated shocks. He was in the midst of a condition known as the "electrical storm."
Electrical storm (ES) refers to a period of cardiac irritability associated with at least three episodes of VT, ventricular fibrillation(VF), or appropriate ICD shocks within a 24-hour period. My own clinical experience suggests that ES has increased in frequency in recent years, although I am not aware of any studies that have methodically documented the numbers. However, as patients with significant cardiac disease are living longer, it should be no surprise that all of us in the ED are seeing patients presenting with ES more than in the past.
