Fosphenytoin for control of electrical storm in acute myocardial infarction and Purkinje fiber‐mediated arrhythmias

Background Purkinje fiber‐mediated arrhythmias in the setting of acute myocardial infarction are poorly responsive to conventional antiarrhythmic therapy, increases overall mortality and often requires radiofrequency ablation (RFA) for control. In this study, we report the use of intravenous Fosphenytoin for the control of arrhythmic storm in patients with acute myocardial infarction. Methods and results Six patients with acute myocardial infarction (5 AW/1 LW) and Purkinje‐triggered ventricular arrhythmias refractory to conventional antiarrhythmics were treated with intravenous Fosphenytoin before considering RFA. Arrhythmia control was obtained in all patients after the initial bolus dose. Breakthrough episodes were seen in 5/6 within 24–36 hours of the initial bolus, necessitating a second bolus. Complete arrhythmia control was obtained in all patients within 72 hours and 5/6 patients were successfully discharged from the hospital. One patient succumbed to sepsis in hospital while another patient succumbed to Sub Dural Hematoma after 3 months. Conclusions Intravenous Fosphenytoin should be considered before RFA for control of Purkinje fiber‐mediated refractory arrhythmias in acute myocardial infarction patients.