Use of Esmolol to treat resistant electrical storm in a patient with decompensated heart failure

Abstract

Background: Ventricular tachycardia storm is a syndrome defined by the presence of at least three episodes of ventricular tachycardia over a 24-hours period, requiring termination by intervention. Standard therapy consists initially of using intravenous betablockers (if left ventricular ejection fraction is preserved) and Amiodarone, in addition to intravenous Lidocaine (in case of ischemic etiology) and light sedation. In the present case, a ventricular tachycardia storm episode is terminated by Esmolol, a particular intravenous betablocker, depside acute heart failure. Case presentation: We report the case of an 89 years old patient that presented for a ventricular tachycardia storm and acute heart failure with reduced left ventricle ejection fraction of coronary ischemic origin, that persisted despite coronary revascularization, oral betablocker, intravenous Amiodarone and Lidocaine, light sedation and multiple electrical cardioversion. Emergency catheter ablation was not feasible due to meteorological conditions. We decided to use an intravenous betablocker despite the presence of acute heart failure. We favored use of intravenous Esmolol over other intravenous betablockers due to its short half-life and thus his rapid elimination, a unique characteristic for Esmolol. Intravenous Esmolol have successfully terminated the ventricular tachycardia without causing cardiogenic shock. Conclusions: Intravenous Esmolol can be used safely in patient with electrical storm in patients with acute heart failure. Close monitoring of the patient remains essential.