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      Multidisciplinary Critical Care Management of Electrical Storm: JACC State-of-the-Art Review.

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          Abstract

          Electrical storm (ES) reflects life-threatening cardiac electrical instability with 3 or more ventricular arrhythmia episodes within 24 hours. Identification of underlying arrhythmogenic cardiac substrate and reversible triggers is essential, as is interrogation and programming of an implantable cardioverter-defibrillator, if present. Medical management includes antiarrhythmic drugs, beta-adrenergic blockade, sedation, and hemodynamic support. The initial intensity of these interventions should be matched to the severity of ES using a stepped-care algorithm involving escalating treatments for higher-risk presentations or recurrent ventricular arrhythmias. Many patients with ES are considered for catheter ablation, which may require the use of temporary mechanical circulatory support. Outcomes after ES are poor, including frequent ES recurrences and deaths caused by progressive heart failure and other cardiac causes. A multidisciplinary collaborative approach to the management of ES is crucial, and evaluation for heart transplantation or palliative care is often appropriate, even for patients who survive the initial episode.

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          Author and article information

          Journal
          J Am Coll Cardiol
          Journal of the American College of Cardiology
          Elsevier BV
          1558-3597
          0735-1097
          Jun 06 2023
          : 81
          : 22
          Affiliations
          [1 ] Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: jentzer.jacob@mayo.edu.
          [2 ] Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
          [3 ] Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri, USA.
          [4 ] Clinical Cardiac Electrophysiology, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
          [5 ] Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA.
          [6 ] Cardiac Electrophysiology Section, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA.
          [7 ] Department of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA.
          [8 ] College of Pharmacy, Purdue University, West Lafayette, Indiana, USA; School of Medicine, Indiana University, Indianapolis, Indiana, USA.
          [9 ] Critical Care Medicine Department, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, Maryland, USA; Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
          Article
          NIHMS1944332 S0735-1097(23)05283-X
          10.1016/j.jacc.2023.03.424
          10683004
          37257955
          c779fe6a-b402-43a5-b842-87461f45dc95
          History

          ventricular tachycardia,ventricular fibrillation,sudden cardiac death,heart failure,implantable cardioverter-defibrillator,shock,myocardial infarction,cardiomyopathy

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