A 39-Year-Old Woman with Ventricular Electrical Storm Treated with Emergency Cardiac Defibrillation Followed by Multidisciplinary Management

Patient: Female, 39-year-old Final Diagnosis: Ventricular electrical storm (VES) Symptoms: Fainting Medication: — Clinical Procedure: Defibrillation • electrophysiological study • endocavitary electrode for temporary cardiac pacing • ICD implantation • radiofrequency ablation • renal replacement therapy • venous-arterial ECMO Specialty: Cardiology OBJECTIVE: Unusual clinical course BACKGROUND: Ventricular electrical storm (VES) is a treatment-resistant ventricular arrhythmia associated with high mortality. This report is of a 39-year-old woman with VES treated with emergency cardiac defibrillation followed by multidisciplinary management. CASE REPORT: A 39-year-old woman, previously diagnosed with eosinophilia of unknown origin and recurrent non-sustained ventricular tachycardias, was admitted to the Department of Invasive Cardiology with VES after an initial anti-arrhythmic approach, analgesia, and defibrillation in the Emergency Department. The patient had a temporary pacing wire implanted, but overdrive therapy was not successful. The medical treatment and multiple defibrillations did not stop the arrythmia. Due to the hemodynamic instability, extracorporeal membrane oxygenation (ECMO) was performed at the Department of Cardiac Surgery. Consequently, the patient was stabilized and an electrophysiology exam and RF ablation of arrhythmogenic focus were conducted in the Department of Cardiology. One day after the procedure, the patient had pulmonary edema caused by pericardial tamponade. The patient was successfully operated on in the Department of Cardiac Surgery. Then, the next complication appeared – a femoral artery embolism – which was treated in the Department of Vascular Surgery. After patient stabilization and exclusion of serious neurological damage, an implantable cardioverter-defibrillator (ICD) was implanted for secondary prevention of sudden cardiac death (SCD). CONCLUSIONS: This case has shown the importance of the rapid diagnosis of VES and emergency management with cardiac defibrillation. Multidisciplinary clinical follow-up is required to investigate and treat any reversible causes and to ensure long-term stabilization of cardiac rhythm.