The role of antiarrhythmic drugs and stellate ganglion block in the acute management of electrical storm

Electrical storm (ES) is a life-threatening condition characterized by at least three separate episodes of ventricular arrhythmia (VAs) over 24 h, each one requiring intervention. Early recognition and prompt treatment are crucial to improving outcomes. In addition to identifying and correcting potential reversible causes, performing acute cardiac life support if required, and interrogating/reprogramming the implantable cardioverter defibrillator in present, the acute management of ES (within 12-24 h upon presentation) nowadays mostly relies on antiarrhythmic drugs and percutaneous left ganglion sympathetic block (PLSGB), that will be the focus of the present review. The choice of the drug should consider several factors, including the aetiology and mechanism of VAs, the underlying cardiac function, and the potential risk of adverse events. Intravenous amiodarone, the most used and recommended drug in the setting of high burden VAs and structural heart disorders, mostly exerts dose and rate infusion dependent antiadrenergic effects in the first hours, and may lead to severe hypotension. PLSGB has an excellent safety-efficacy profile and can be easily performed by trained cardiologists at bedside.