Amiodarone and lidocaine infusion for treatment of ventricular tachycardia storm in an emergency setting: Case report

This report describes a case of ventricular tachycardia (VT) storm managed in the emergency department prior to transfer for automatic implantable cardioverter-defibrillator (AICD) placement. VT storm is associated with significant in-hospital and 6-month mortality, necessitating emergent stabilization and definitive secondary prevention. While ACLS and antiarrhythmic drugs (AAD) are the mainstays of emergency management early referral is indicated for AICD placement, catheter ablation, and/or sympathetic cardiac denervation. In the setting of sustained or recurrent VT (including VT storm), amiodarone and/or lidocaine can be administered not only as boluses but also as infusions. This strategy can stabilize the patient for transfer (if needed) and avoid escalation to intubation and sedation for central sympathetic blockade, which would necessitate admission to intensive care.