Electrical storm: Is right ventricular pacing dangerous?

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. (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 8 No. 3, March 2017. ISSN – [0976-3198] Int J Case Rep Images 2017;8(3):191–195. www.ijcasereportsandimages.com Cooper et al. 191 CASE REPORT PEER REVIEWED | OPEN ACCESS Electrical storm: Is right ventricular pacing dangerous? Daniel Mark Cooper, Kathleen M. Kennedy