When Medication Fails: Choosing Palliative Care in Refractory Cases of Electrical Storm

Electrical storm is most commonly developed through ischemic progression that allows surreptitious isthmuses of tissue to propagate episodes of ventricular tachycardia or ventricular fibrillation. This is a case of an elderly man at a community hospital who presented with syncope and who developed progressively worsening ischemic damage to his heart that evolved into an electrical storm. Given his multiple comorbidities and the perioperative risks, he was not a candidate for ablative therapies, leaving medication the only option for his treatment course. Numerous antiarrhythmic regimens were attempted but were ultimately ineffective at reversing the progressive damage caused by the electrical storm. This case illustrates the challenges of treatment in cases where ablation is not an option, and the value of palliative care in providing patient-centered care.

Keywords:Electrical storm; Ablation; Palliative care

Abbreviations:ES: Electrical storm; AICD: Automatic Implantable Cardioverter-Defibrillator; VT: Ventricular tachycardia; VF: Ventricular fibrillation; CABG: Coronary artery bypass grafting; CKD: Chronic kidney disease