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Management of ventricular tachycardia storm
  1. Junaid Zaman1,2,
  2. Sharad Agarwal3
  1. 1 Cardiology, Royal Brompton Hospital, London, UK
  2. 2 Cardiac Rhythm Management, Royal Papworth Hospital, Cambridge, Cambridgeshire, UK
  3. 3 Department of Cardiology, Royal Papworth Hospital NHS Trust, Cambridge, UK
  1. Correspondence to Dr Sharad Agarwal, Department of Cardiology, Royal Papworth Hospital NHS Trust, Cambridge, UK; sharad.agarwal{at}nhs.net

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Learning objectives

  • To define the diagnostic criteria for ventricular tachycardia storm.

  • To outline the initial management of ventricular tachycardia storm in outpatient and inpatient settings.

  • To know which specialty teams should be involved in the ongoing care of the patient.

Introduction

Ventricular arrhythmias present in many ways, ranging from isolated premature beats to sustained ventricular tachycardia (VT). They can occur in patients with or without structural heart diseases and at a wide spectrum of ages. Knowledge of acute management of sustained VT is therefore a priority for all cardiologists, as confirmed in Section 2.20 of the European Society of Cardiology (ESC) Core Curriculum in Cardiology. This article will provide the latest overview on the management of an intimidating and life-threatening condition: VT storm. It will also address the unique challenges posed by the increased use of remote monitoring in the routine care of patients with animplantable cardioverter defibrillator (ICD).

Definition

According to the latest consensus guidelines, VT is defined as cardiac arrhythmia of ≥3 consecutive complexes originating in the ventricles at a rate of >100 beats per minute (cycle length: <600 ms).1 Sustained VT is defined as that lasting more than 30 s or requiring an intervention prior to that due to haemodynamic instability.

VT storm is defined as three or more episodes of sustained VT within a 24-hour period, each requiring termination by an intervention such as cardioversion, antitachycardia pacing (ATP) or defibrillation.2 In patients without an ICD, it has been further defined as (1) VT recurring soon after (within 5 min) termination of another VT episode; and (2) sustained and non-sustained VT resulting in a total number of ventricular ectopic beats greater than sinus beats in a 24-hour period.3

In patients with an ICD, the definition is prone to (1) underdetection if the rate of the device at which it starts counting beats …

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Footnotes

  • Twitter @drjunaidzaman

  • Contributors Both authors have participated in structuring the layout of the manuscript, written content and finalisation of the document.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Author note References which include a * are considered to be key references.

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