Intravenous verapamil as salvage therapy for reperfusion-related refractory electrical storm following acute inferior myocardial infarction: a case report

Background Electrical storm following acute myocardial infarction is associated with high mortality. A subset of these cases is refractory to conventional therapies, including amiodarone, beta-blockers, and defibrillation. The calcium channel blocker verapamil is typically used for idiopathic ventricular tachycardia but must be used cautiously in patients with acute myocardial infarction, heart failure, or high-grade atrioventricular (AV) block. Case presentation A 52-year-old male patient underwent primary percutaneous coronary intervention for acute inferior ST-segment elevation myocardial infarction. He developed refractory electrical storms on the 3rd and 5th postoperative days, characterized by recurrent ventricular tachycardia and ventricular fibrillation with severe hypokalemia and hypocalcemia. Standard resuscitative measures, including potassium supplementation, repeated electrical cardioversion, and intravenous lidocaine, as well as combination therapy with amiodarone and esmolol, were ineffective. During the third episode of electrical storm, after 90 min of unsuccessful resuscitation, 5 mg of intravenous verapamil was administered. The patient’s sinus rhythm was promptly restored and maintained. Subsequent management included temporary pacemaker implantation and a second percutaneous coronary intervention. The patient was eventually discharged in stable condition. Conclusions In this single confounded case, intravenous verapamil appeared to have a potential salvage effect for reperfusion-related eletrical storm refractory to conventional treatment, but causality cannot be established. The case underscores the importance of early temporary pacing, aggressive electrolyte correctcion, and cautious consideration of verapamil only as a last resort under close monitoring.