Arrhythmic Storm and ICDs

For the ICD folks who have experienced arrhythmic storm(s) (i.e. multiple episodes of VT or VF over a short period of time 24hrs):

What drugs/actions made it better? What drugs/actions made it worse? What is your current diagnosis? What do you do when you feel an episode might be coming on?

For me:

1.Isoproterenol and overdrive pacing at 90bpm make it better.

2. Amiodarone and Lidocaine don't work. Beta blockers (propranolol and IV esmolol) make it much much worse.

3. Idiopathic VF, short-coupled VF.

4. Take 0.5mg Xanax, lay down, try to focus on breathing.

p.s. This paper has a great table showing the management of electric storms based on the underlying condition.

https://www.sciencedirect.com/science/article/pii/S1880427614000714

2 Comments

Interesting post

by Good Dog - 2022-03-31 10:33:47

I found your post interesting and I think it may be helpful for others with similar problems to follow with their info.

I do not have much to offer, because I do not have the same condition. However, I found it interesting that stress/anxiety apparently plays some roll in your issues. I can certainly identify with that as there was a time in my life (about 25 years ago) when stress and caffeine caused some significant arrhythmias for me. The interesting part of it was that while my heart was doing all these crazy things (palpitations and various arrhythmias) which made me feel terrible and very scared, I had no idea why and even my EP couldn't figure it out. I wore a holter monitor to investigate. He did suggest I give-up caffeine which I did. However I still suffered episodes and was having trouble sleeping. I knew I was suffering from some stress, but didn't attribute it to the problem at that time. At about the same time my GP prescribed low dose xanax to help me sleep. Frankly, it was amazing how much that helped my heart issues. Those irregular episodes just disappeared. I haven't had any since. I certainly cannot attribute it entirely to the xanax, but I am sure it played some role. I still take 0.25 to 0.5 mg at night to help me sleep. I know how addictive it is, so I am very careful with it. I have since learned and believe strongly that stress can do a lot of terrible things to us, so I now believe that it played a much bigger role in my problems then I knew back then.

Oddities....

by BOBTHOM - 2022-04-02 13:27:05

I have a basic ICD and I apparently feel things more than most for some reason.  I throw many PVC's if that's what you are referring to and honestly I beleive the shocks/therapies that I have recieved is from multiple PVC's.  But in answer to your question for what makes things better for me.  In addition to heart failure and peripheral artery disease I also have COPD and beleive it or not my Albuterol inhaler actually lowers and stabalizes my heart rate.  For longer lasting relief I have found AlkaSeltzer Cough and Cold (the fizzy tablets not the gummies) gives me about 10/12 hours and lets me sleep thru the night.  The Amiodarone seemed to work for a while but now drives my heart rate low and extends my QT something or another that may be causing bradycardia.  The Bisoprolol (beta blocker) also reduces my heart rate.  The Enalapril (ace inhibitor) tends to help reduce the impact of adrenaline on my heart rate somehow thru being an angiotensin blocker. I have also found that Magnesium and L-Arginine.slightly reduce my heart rate.  I don't know if that answers any of your questions or if anyone else has this kind of experience but this is how my body reacts and I use it to manage my heat issues as best as I can.

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