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Case Reports
. 2019 Oct-Dec;13(4):359-361.
doi: 10.4103/sja.SJA_745_18.

Epinephrine-induced electrical storm after aortic surgery

Adam L Weinstein  1 , Neal S Gerstein  2 , Josh I Santos  2 , Peter M Schulman  3
Affiliations
Case Reports

Epinephrine-induced electrical storm after aortic surgery

Adam L Weinstein et al. Saudi J Anaesth. 2019 Oct-Dec.

Abstract

Electrical storm (ES) is a potentially lethal syndrome defined as three or more sustained episodes of ventricular tachycardia or ventricular fibrillation within 24 h. There are multiple inciting factors for ES, one of which involves excess catecholamine (endogenous and exogenous) effects. Exogenous catecholamines used for hemodynamic support can paradoxically engender or exacerbate an underling arrhythmia leading to ES. We report on an 63-year-old man who presented for repair of an ascending aortic dissection. After cardiopulmonary bypass separation assisted with high-dose epinephrine, ES developed requiring over 40 defibrillatory shocks. The epinephrine infusion was held and within 5 min, the ES self-terminated. ES in the context of cardiovascular surgery with the use of epinephrine for hemodynamic support has not be previously reported. Clinicians need to be cognizant of the seemingly paradoxical effect of epinephrine to induce ES. Initial ES treatment involves acute stabilization (treating or removing exacerbating factors (i.e., excess catecholamines)).

Keywords: Electric storm; ventricular fibrillation; ventricular tachycardia.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
EKG demonstrating the patient's accelerated junction rhythm upon cessation of epinephrine and a period of 40 episodes of ventricular fibrillation
See this image and copyright information in PMC

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