Temporary rapid pacing to prevent ventricular fibrillation recurrence in electrical storm refractory to medical therapy

Introduction Drug-refractory electrical storm due to VF or polymorphic VT is rare but has poor prognosis. Case reports have suggested temporary pacing could be useful to suppress recurrent arrhythmia. Methods All consecutive patients admitted to the Cardiac Intensive Care Unit of our institution from 2009 to 2017 for VF electrical storm refractory to medical therapy in whom temporary pacing was used at the acute phase were included. Results Ten patients met inclusion criteria. Nine men and one woman mean age was 67 ± 21. Two patients were already equipped with an ICD in secondary prevention. Mean number of arrhythmic events during electrical storm was 28.7 ± 43.5. Electrical storm was related to a recent ischemic event (6 patients), Brugada syndrome with fever episode (1), or Flecainide intoxication (1). Cause remained unknown in 2 patients. Mean LVEF was 36 ± 15%. Medical therapy using Amiodarone (6), B-blockers (4), and Lidocaine (5) for ischemic patients or Isoproterenol for Brugada syndrome had failed in all patients. Rapid pacing (99.0 ± 20.8 bpm) at the atrial (4), ventricular (5), or both (1) levels was initiated at this stage. Pacing therapy was ineffective with the Flecainide intoxication and the idiopathic VF patient, reduced the number of VF episodes with the Brugada syndrome patient and completely suppressed arrhythmias in all other patients. Atrial and ventricular pacing were equally effective. Patients with effective temporary pacing underwent ablation (2), or were managed medically (3). There was no serious pacing-related complication. Conclusion Temporary pacing seems to be a quick and safe therapeutic option in VF electrical storm. It's particularly effective in patients with recent ischemic events in which it can be used as a bridge to ablation or to await medical therapy optimization.