Management of ventricular tachycardia storm

### Learning objectives Ventricular arrhythmias present in many ways, ranging from isolated premature beats to sustained ventricular tachycardia (VT). They can occur in patients with or without structural heart diseases and at a wide spectrum of ages. Knowledge of acute management of sustained VT is therefore a priority for all cardiologists, as confirmed in Section 2.20 of the European Society of Cardiology (ESC) Core Curriculum in Cardiology. This article will provide the latest overview on the management of an intimidating and life-threatening condition: VT storm. It will also address the unique challenges posed by the increased use of remote monitoring in the routine care of patients with animplantable cardioverter defibrillator (ICD). According to the latest consensus guidelines, VT is defined as cardiac arrhythmia of ≥3 consecutive complexes originating in the ventricles at a rate of >100 beats per minute (cycle length: <600 ms).1 Sustained VT is defined as that lasting more than 30 s or requiring an intervention prior to that due to haemodynamic instability. VT storm is defined as three or more episodes of sustained VT within a 24-hour period, each requiring termination by an intervention such as cardioversion, antitachycardia pacing (ATP) or defibrillation.2 In patients without an ICD, it has been further defined as (1) VT recurring soon after (within 5 min) termination of another VT episode; and (2) sustained and non-sustained VT resulting in a total number of ventricular ectopic beats greater than sinus beats in a 24-hour period.3 In patients with an ICD, the definition is prone to (1) underdetection if the rate of the device at which it starts counting beats …