Contemporary management of ventricular electrical storm in Europe: results of a European Heart Rhythm Association Survey

Enrico Baldi, Giulio Conte, Katja Zeppenfeld, Radosław Lenarczyk, Jose M Guerra, Michal M Farkowski, Carlo de Asmundis, Serge Boveda

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Electrical storm (ES) is a predictor of mortality, and its treatment is challenging. Moreover, not all potential therapeutic strategies are available in all hospitals, and a standardized approach among European centres is lacking. The aim of this European Heart Rhythm Association (EHRA) survey was to assess the current management of patients with ES both in the acute and post-acute phases in 102 different European centres. A 20-item online questionnaire was sent out to the EHRA Research Network Centres. The median number of patients with ES treated annually per centre is 10 (IQR 5-15). The possibility of using autonomic modulation (e.g. percutaneous stellate ganglion block or thoracic epidural anaesthesia) for the acute ES treatment is available in only 29.3% of the centres. Moreover, although over 80% of centres perform ventricular tachycardia ablation, this procedure is available 24/7 in only 16.5% of the hospitals. There is a significant heterogeneity among centres regarding the availability of AADs and their use before deciding to proceed with a non-AAD strategy; specifically, 4.4% of centres use only one drug, 33.3% use two drugs, and 12.2% >two drugs, while about 50% of the centres decide based on individual patient's characteristics. Regarding the type of AADs used for the acute and post-acute management of ES patients, important variability is reported depending upon the underlying heart disease. Most patients considered for percutaneous ablation have structural heart disease. Only 46% of centres refer patients to psychological counselling after ES.

Bibliographical note

Funding Information:
The production of this document is under the responsibility of the Scientific Initiatives Committee of the European Heart Rhythm Association: Serge Boveda (Chair), Giulio Conte (Co-Chair), Ante Anic, Sergio Barra, Julian K.R. Chun, Carlo de Asmundis, Nikolaos Dagres, Michal M. Farkowski, Jose Guerra, Konstantinos E. Iliodromitis, Kristine Jubele, Jedrzej Kosiuk, Eloi Marijon, Rui Providencia, Frits Prinzen. The authors acknowledge the EHRA Scientific Research Network centres participating in this survey. A list of these centres can be found on the EHRA website.

Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.

Copyright 2023 Elsevier B.V., All rights reserved.


  • Arrhythmic storm
  • Autonomic modulation
  • Catheter ablation
  • EHRA survey
  • Electrical storm
  • Ventricular arrhythmias


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