Ventricular electrical storm refractory to 250 defibrillations during myomectomy: the critical role of VA-ECMO and multidisciplinary management

Ventricular electrical storm (VES) is a critical cardiac emergency with high mortality, often refractory to treatment. They are typically associated with certain cardiovascular diseases, cardiac surgeries, hereditary arrhythmia syndromes or ICD shocks. Malignant intraoperative VES during non-cardiac surgeries represents a rare subset within cardiovascular medicine, yet their under-representation in clinical literature is disproportionate to the critical nature of the condition. This case report describes a previously healthy patient who developed sudden intraoperative ventricular fibrillation (VF) during an elective myomectomy, progressing to an overwhelmingly malignant VES. A family history of sudden cardiac death suggested a genetic arrhythmic syndrome. Management required over 250 defibrillations, veno-arterial extracorporeal membrane oxygenation (VA-ECMO), intra-aortic balloon pump (IABP) and a multidisciplinary approach. Despite poor prognostic indicators, the patient survived, an exceptionally rare outcome. This case underscores the importance of early mechanical circulatory support and highlights the potential for recovery even in critical scenarios challenging conventional prognostic expectations.