VT storm

Multiple episodes of VT/VF in a short period of time

•e.g., several episodes in one day (>3 sustained episodes)

May result in several shocks

•PTSD

Treatment

•Hospital admission

•Medications – Amiodarone (III), lignocaine (Ib), beta blockers (II), magnesium, calcium channel blockers (IV), procainamide or quinidine (Ia)

•VT ablation

Unnesssary shocks

VT storm may result in unnecessary shocks

This may occur when

•there are several short episodes (NSVT) which are all counted in one event on the device

•A VT is successfully terminated with therapy, but reinitiates shortly after and is all counted as one episode

Therefore instead of being treated with ATP (which is usually 1st line/s of therapy, the device keeps moving on to the next treatment option, which may be multiple shocks

Causes of VT storms

Acute ischemia (PMVT and VF)

Heart failure exacerbation / LV dysfunction

Thyroid dysfunction

Metabolic abnormalities

Drug effects

•(diuretics- can cause imbalance in metabolics, drugs causing proarrhythmia)

Note: multiple shocks can cause changes in repolarization and elevations in troponin I