From the Guidelines
To treat acute ventricular tachycardia (VT) storm, immediately stabilize the patient with IV amiodarone and intravenous beta blockers, as these may be reasonable in patients with VT storm. The treatment of VT storm is a medical emergency that requires prompt attention to prevent high mortality rates exceeding 50% if left untreated 1. The use of IV amiodarone and beta blockers is supported by the acc/aha/esc 2006 guidelines, which suggest that these treatments may be reasonable in patients with VT storm, although the level of evidence is C 1.
Key Considerations
- Correct underlying causes such as electrolyte abnormalities (maintain potassium >4.0 mEq/L and magnesium >2.0 mg/dL), ischemia, or heart failure.
- For hemodynamically unstable patients, perform immediate electrical cardioversion or defibrillation at 200 joules (biphasic).
- For refractory cases, consider deep sedation with propofol or midazolam, mechanical ventilation, and stellate ganglion blockade.
- Overdrive pacing at 10-20 beats faster than the VT rate may terminate the arrhythmia.
- Catheter ablation should be considered for recurrent episodes.
Additional Treatment Options
- Overdrive pacing or general anesthesia may be considered for patients with frequently recurring or incessant VT, as suggested by the acc/aha/esc 2006 guidelines 1.
- Spinal cord modulation may be considered for some patients with frequently recurring or incessant VT, although the level of evidence is C 1.
- Revascularization and beta blockade followed by intravenous antiarrhythmic drugs such as procainamide or amiodarone are recommended for patients with recurrent or incessant polymorphic VT due to acute myocardial ischemia 1.
From the FDA Drug Label
Amiodarone hydrochloride injection is indicated for initiation of treatment and prophylaxis of frequently recurring ventricular fibrillation (VF) and hemodynamically unstable ventricular tachycardia (VT) in patients refractory to other therapy. Use amiodarone for acute treatment until the patient's ventricular arrhythmias are stabilized. The recommended starting dose of amiodarone is about 1000 mg over the first 24 hours of therapy, In the event of breakthrough episodes of VF or hemodynamically unstable VT, use 150 mg supplemental infusions of amiodarone
The treatment for acute Ventricular Tachycardia (VT) storm is amiodarone (IV). The recommended dose is about 1000 mg over the first 24 hours of therapy. If there are breakthrough episodes of VT, a 150 mg supplemental infusion of amiodarone can be used 2, 2.
From the Research
Treatment for Acute Ventricular Tachycardia (VT) Storm
The treatment for acute Ventricular Tachycardia (VT) storm involves a combination of medications, interventions, and management strategies. Some of the key approaches include:
- Sympathetic blockade with β-blockers, usually in combination with intravenous (IV) amiodarone, which has been shown to be highly effective in suppressing VT storm 3
- The use of nonselective β-blockers such as propranolol, which has been found to be superior to β1-selective blockers like metoprolol in managing VT storm 3
- Intravenous amiodarone, lignocaine, overdrive pacing, and intra-aortic balloon pump counterpulsation, which have been found to be useful in controlling arrhythmias 4
- Deep sedation as a temporary bridge to definitive treatment of ventricular arrhythmia storm, which has been shown to be effective and safe in refractory cases 5
- The combination of low doses of beta-blockers and amiodarone, which has been found to be effective in treating refractory ventricular tachycardia 6
Management Strategies
Some of the key management strategies for VT storm include:
- Sedation and antiarrhythmic drugs to acute management of ES 7
- Correction of precipitating factors such as myocardial ischemia, acute decompensation of heart failure, metabolic and electrolyte disorders, and drug side-effects 7
- Radiofrequency catheter ablation, which has been found to be superior to antiarrhythmic drugs in suppressing VT storm 7
- Optimization of ICD programming to reduce the burden of further appropriate and inappropriate shocks 7
Triggers and Underlying Conditions
VT storm can be triggered by various factors, including:
- Acute myocardial infarction 4
- Decompenated heart failure 4
- Systemic inflammatory response syndrome on a background of non-ischemic dilated cardiomyopathy 4
- Bradycardia-induced polymorphic VT 4
- Underlying conditions such as coronary artery disease, arrhythmogenic right ventricular dysplasia, dilated cardiomyopathy, and valvular disease 6