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Multidisciplinary Critical Care Management of Electrical Storm: JACC State-of-the-Art Review (JACC June 2023-1)
Electrical storm (ES) reflects life-threatening cardiac electrical instability with 3 or more ventricular arrhythmia (VA) 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 anti-arrhythmic 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 VA. 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 due to 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. 

Valentin Fuster, MD, PhD, MACC

CME Editor
Ragavendra R. Baliga, MD

Jacob C. Jentzer, MD
Michael A. Solomon, MD, MBA
James E. Tisdale, PharmD
Jonathan Chrispin, MD

Important Dates
Date of Release: May 29, 2023
Term of Approval/Date of CME/MOC Expiration: May 28, 2024
Availability: On-Demand
Expires on May 28, 2024
Cost: FREE
Credit Offered:
1 CME Credit
1 ABIM-MOC Point
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