Ablation of Electrical Storm

In a variety of clinical settings, we occasionally experience the clusters of ventricular tachycardia (VT) or/and ventricular fibrillation (VF) requiring the repeated cardioversions, socalled electrical storm (ES). Recently catheter ablation techniques have been applied to suppress the refractory ES. In acute or subacute phase of myocardial infarction (MI), polymorphic VT or VF are the main arrhythmias of ES and their triggers originating in Purkinje fibers are the common targets of ablation, sometimes resulting in the substrate modification by the extensive ablation on Purkinje system. In the remote phase of MI, the scar related reentrant VT is the main target of ablation. Similarly, the ES associated with structurally normal heart such as idiopathic VF also have some specific mechanisms. Therefore, it is important for the physicians to be well versed in the disease-specific mechanism and the most susceptible target to prepare the urgent application of catheter ablation.