This topic has never become a CICM SAQ but is sufficiently awesome to merit a whole long discussion. This "storm" concept has no fixed scientific definition. VT storm can be managed with drugs, of which the first line agents are amiodarone, lignocaine and beta-blockers. Second line drug therapy may include phenytoin and other class 1 agents like mexilitine. Cardioversion and overdrive pacing are valid options. Lastly, one may resort to stellate ganglion blockade, thoracic epidural, and radiofrequency ablation. Invasive surgical procedures like thoracic sympathectomy and endocardial resection are reserved for special cases which can benefit from neither drugs nor RFA.