Spinal cord stimulation for electrical storm refractory to conventional medical treatment: An emerging indication?

Objective To observe the effect of thoracic spinal cord stimulation with dual octipolar epidural electrodes on episodes of ventricular tachycardia and ventricular fibrillation in a patient with nonischemic familial cardiomyopathy and severe electrical storm refractory to conventional medical treatment. Results Following implantation of temporary bilateral octipolar thoracic epidural electrodes and constant low-grade stimulation, episodes of ventricular tachycardia and ventricular fibrillation were eradicated, and a permanent system was surgically implanted uneventfully. Electrical storm ceased thereafter, though ventricular function from progressive cardiomyopathy worsened, requiring heart transplantation several months later. Conclusions Spinal cord stimulation may play an important therapeutic role in the treatment of refractory electrical storm when conventional medical treatments have failed. The mechanism by which stimulation of the spinal cord confers a therapeutic effect is not completely understood, although direct modulation of sympathetic and parasympathetic tone in the cardiac conduction system is most likely, based on animal models of ischemia-induced ventricular tachycardia.