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. 

Editors
Editor-in-Chief
Valentin Fuster, MD, PhD, MACC

CME Editor
Ragavendra R. Baliga, MD

Authors
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