C48. How to handle VT storm in ICD patient : serial case report

Ventricular tachycardia (VT) storm can cause sudden death in patients with trans-venous implantable cardioverter-defibrillator (ICD) and adversely affects prognosis in survivors. Patients with recurrent shocks have a poor quality of life and increased mortality rates. The purpose of this case series was to discuss the available treatment option for VT storm in ICD patients.

We reported two patients with VT storm on ICD. Both patients had palpitation, clinical heart failure, and recurrent shocks from ICD with appropriate rhythms. The first case had hypokalemia with ICD recording showed 45 episodes of VT, 45 antitachycardia pacing (ATP), and 5 shocks therapy. The second case had hypomagnesemia with ICD recording showed 195 episodes of VT, 42 ATP, and 3 shocks therapy. Management approaches to these patients include ICD reprogramming, correcting electrolyte abnormalities, treating heart failure and administering anti-arrhythmic drugs (AADs).

VT storm on ICD refers to three or more appropriate therapies for ventricular tachyarrhythmias, including ATP or shocks, within 24 hours. The known triggers must be treated, such as electrolyte disturbance and worsened heart failure. AADs therapy could suppress VT and increased the tachycardia cycle length (TCL) so that the response to ATP is better. ICD reprogramming include higher heart rate treshold, longer detection period, and improving ATP programming. Catheter ablation and cardiac sympathetic denervation (CSD) may be an option if VT storm persists.