Effectiveness of amiodarone and lidocaine combination in termination of monomorphic ventricular tachycardia electrical storm in patient with dilated cardiomyopathy and severe left ventricular dysfunction

Electrical storm is life threatening condition that is defined by 3 episodes of sustained ventricular tachycardia (VT), Ventricular fibrillation, or appropriate shocks from an ICD within 24h. In hospitals lacking electrophysiology service, the therapy includes rapid recognition of the condition, treatment of the reversible causes, immediate start of antiarrhythmic drugs and sedation. Catheter ablation should be considered in drug refractory electrical storm.we present a case of dilated cardiomyopathy with severe left ventricular dysfunction came with electrical storm of monomorphic ventricular tachycardia. He was found to have hyperkalemia and metabolic acidosis as precipitating factors which were aggressively treated. He received total of 43 electrical cardioversion shocks for hemodynamic unstable VT. Concomitant administration of intravenous infusion of amiodarone and lidocaine was an effective approach to control the electrical storm within24 h of starting both.