{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:40:02Z","timestamp":1756323602029,"version":"3.44.0"},"reference-count":15,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,6,28]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:p>Ventricular electrical storm (VES) is a critical cardiac emergency with high mortality, often refractory to treatment. They are typically associated with certain cardiovascular diseases, cardiac surgeries, hereditary arrhythmia syndromes or ICD shocks. Malignant intraoperative VES during non-cardiac surgeries represents a rare subset within cardiovascular medicine, yet their under-representation in clinical literature is disproportionate to the critical nature of the condition. This case report describes a previously healthy patient who developed sudden intraoperative ventricular fibrillation (VF) during an elective myomectomy, progressing to an overwhelmingly malignant VES. A family history of sudden cardiac death suggested a genetic arrhythmic syndrome. Management required over 250 defibrillations, veno-arterial extracorporeal membrane oxygenation (VA-ECMO), intra-aortic balloon pump (IABP) and a multidisciplinary approach. Despite poor prognostic indicators, the patient survived, an exceptionally rare outcome. This case underscores the importance of early mechanical circulatory support and highlights the potential for recovery even in critical scenarios challenging conventional prognostic expectations.<\/jats:p>","DOI":"10.1136\/bcr-2025-265936","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T03:40:29Z","timestamp":1752464429000},"page":"e265936","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Ventricular electrical storm refractory to 250 defibrillations during myomectomy: the critical role of VA-ECMO and multidisciplinary management"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8768-8239","authenticated-orcid":false,"given":"Imthiaz","family":"Manoly","sequence":"first","affiliation":[{"name":"Cardio-Thoracic Surgery, Mohammed Bin Rashid University of Medicine and Health Sciences College of Medicine, Dubai, Dubai, UAE"},{"name":"Dubai Hospital, Dubai Academic Health Corporation, Dubai, Dubai, UAE"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary Ann","family":"Boniface","sequence":"additional","affiliation":[{"name":"Cardio-Thoracic Surgery, Mohammed Bin Rashid University of Medicine and Health Sciences College of Medicine, Dubai, Dubai, UAE"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fayaz Mohammed","family":"Khazi","sequence":"additional","affiliation":[{"name":"Dubai Hospital, Dubai Academic Health Corporation, Dubai, Dubai, UAE"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Obaid","family":"Aljassim","sequence":"additional","affiliation":[{"name":"Dubai Hospital, Dubai Academic Health Corporation, Dubai, Dubai, UAE"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,7,13]]},"reference":[{"key":"2025082712100983000_18.7.e265936.1","doi-asserted-by":"crossref","first-page":"1768","DOI":"10.1093\/europace\/euaa232","article-title":"Management of ventricular electrical storm: a contemporary appraisal","volume":"22","author":"Kowlgi","year":"2020","journal-title":"Europace"},{"key":"2025082712100983000_18.7.e265936.2","doi-asserted-by":"crossref","first-page":"A966","DOI":"10.1016\/j.chest.2020.08.899","article-title":"VENTRICULAR TACHYCARDIA STORM REFRACTORY TO CARDIOVERSION","volume":"158","author":"Niaz","year":"2020","journal-title":"Chest"},{"key":"2025082712100983000_18.7.e265936.3","first-page":"111","article-title":"The evaluation and management of electrical storm","volume":"38","author":"Eifling","year":"2011","journal-title":"Tex Heart Inst J"},{"key":"2025082712100983000_18.7.e265936.4","doi-asserted-by":"crossref","first-page":"C242","DOI":"10.1093\/eurheartjsupp\/suad048","article-title":"Electrical storm management in structural heart disease","volume":"25","author":"Dusi","year":"2023","journal-title":"Eur Heart J Suppl"},{"key":"2025082712100983000_18.7.e265936.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2007.07.013"},{"key":"2025082712100983000_18.7.e265936.6","doi-asserted-by":"publisher","DOI":"10.1136\/postgradmedj-2015-133550"},{"key":"2025082712100983000_18.7.e265936.7","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1016\/j.ajem.2020.04.017","article-title":"Electrical storm: A focused review for the emergency physician","volume":"38","author":"Dyer","year":"2020","journal-title":"Am J Emerg Med"},{"key":"2025082712100983000_18.7.e265936.8","doi-asserted-by":"crossref","first-page":"92","DOI":"10.3389\/fcvm.2019.00092","article-title":"CPVT: Arrhythmogenesis, Therapeutic Management, and Future Perspectives. A Brief Review of the Literature","volume":"6","author":"Baltogiannis","year":"2019","journal-title":"Front Cardiovasc Med"},{"key":"2025082712100983000_18.7.e265936.9","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.103.16.2066"},{"key":"2025082712100983000_18.7.e265936.10","article-title":"Life-Threatening Electrical Storm Following Liver Transplantation: A Case Report","volume":"25","author":"Araujo Coelho","year":"2024","journal-title":"Am J Case Rep"},{"key":"2025082712100983000_18.7.e265936.11","doi-asserted-by":"crossref","first-page":"S162","DOI":"10.1053\/j.jvca.2019.07.044","article-title":"Cardiogenic shock treated with multiple mechanical circulatory support devices","volume":"33","author":"Giunta","year":"2019","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2025082712100983000_18.7.e265936.12","doi-asserted-by":"publisher","DOI":"10.1177\/0267659114546033"},{"key":"2025082712100983000_18.7.e265936.13","doi-asserted-by":"crossref","DOI":"10.1093\/europace\/euad091","article-title":"Spotlight on the 2022 ESC guideline management of ventricular arrhythmias and prevention of sudden cardiac death: 10 novel key aspects","volume":"25","author":"K\u00f6nemann","year":"2023","journal-title":"Europace"},{"key":"2025082712100983000_18.7.e265936.14","doi-asserted-by":"crossref","first-page":"2189","DOI":"10.1016\/j.jacc.2023.03.424","article-title":"Multidisciplinary Critical Care Management of Electrical Storm: JACC State-of-the-Art Review","volume":"81","author":"Jentzer","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"2025082712100983000_18.7.e265936.15","unstructured":"Teniola B , Spektor B . 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