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Background and Aims Electrical storm (ES) is a state of cardiac electrical instability characterized by multiple episodes of ventricular arrhythmias. It is a very rare condition during pregnancy, especially without a history of heart disease. We present a clinical case of a woman with a twin pregnancy who developed a very challenging and refractory ES.

Methods A 28-year-old woman with a bicorionic/biamniotic twin pregnancy and a history of anxiety presented to our center at 32 weeks of gestation due to dysuria and diarrhea, which started one day after she began taking quetiapine. She was admitted for evaluation and started on nifedipine for tocolysis. After one hour, the patient developed polymorphic ventricular tachycardia (VT) with significant hemodynamic instability. Due to the inefficacy of pharmacological and synchronized cardioversion, an emergent cesarean section was performed. The twins were born without complications. However, she maintained the VT and was admitted to the intensive care unit. After six days of numerous attempts at synchronized cardioversion and pharmacological therapy, a successful ablation of the apical focus of the left ventricle was performed, resulting in a return to sinus rhythm.

Results This case occurred in a pregnant woman with no previous heart disease. Ablation was not immediately available as a specialized team was required in our department. The only way to achieve hemodynamic improvement was through the use of isoproterenol. All the other drugs and synchronized cardioversion had no significant effect. She recovered after a few weeks with no significant morbidity.

Conclusions A structured, team-based management approach is paramount for these clinical cases