ECG Challenges: Electrical Storm in Implantable Cardioverter Defibrillator Recipients
Gerard B. Hannibal RN, MSN, PCCN
Gerard B. Hannibal RN, MSN, PCCN; Department Editor

$3.95 		AACN Advanced Critical Care
March 2012 
Volume 23  Number 1
Pages 108 - 112
 
  PDF Version Available!

ABSTRACT
Electrical storm (ES) in patients who have implantable cardioverter defibrillators (ICDs) is a serious medical problem that has become more common as increasing numbers of individuals survive myocardial infarction (MI) and experience heart failure. Patients with defibrillator or ICD storm go to clinics, emergency departments, progressive care units, and intensive care units for monitoring and evaluation. Acute inpatient care and treatment revolve around device interrogation, assessment of the cause and triggers, physiological treatment, device therapy adjustment, and emotional support. Critical care nurses in all settings should be aware of the many issues related to the care of these patients.The treatment of ventricular cardiac arrhythmias is very different today than it was in the early days of cardiac monitoring. The focus in the first decades of cardiac intensive care was the prevention and treatment of cardiac arrest in MI patients. This focus supported a common practice (not confirmed by randomized trials) that suppression of ventricular arrhythmias would prevent ventricular fibrillation (VF) and sudden cardiac death (SCD). The groundbreaking Cardiac Arrhythmia Suppression Trial (CAST) of the mid-1980s permanently changed the way we treat patients with ventricular arrhythmias.1The CAST was a well-designed, randomly controlled clinical trial that looked at the question of suppression of cardiac arrhythmias in relation to mortality. MI patients with ventricular arrhythmias were randomized to anti-arrhythmia drugs. They were given the drug to ensure that their rhythms were actually suppressed (ie, that the drug worked as expected). The patients were then randomized again to either a placebo or the medication that worked to suppress the arrhythmia. Famously, the trial ended early because of increased mortality in the experimental group.1Not only did the CAST indicate that there is no benefit to suppression, but it also suggested that the drugs used for suppression

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