Multidisciplinary Approach to Ventricular Arrhythmias in the CICU: Integrating Mechanical Circulatory Support, Ablation, and Emerging Therapies

Background/Objectives: The management of ventricular arrhythmias (VAs) within cardiac intensive care units (CICUs) is undergoing a significant transformation. This review aims to analyze the historical transition from a narrow focus on arrhythmia-specific treatments toward on the multidisciplinary heart rhythm team. Methods: A narrative revies was conducted. Results: Effective management of electrical storm (ES) requires prompt attenuation of sympathetic hyperactivity, with a preference for non-selective beta-blockers and the implementation of deep sedation. The use of mechanical circulatory support (MCS) has emerged as a mechanical antiarrhythmic strategy by facilitating ventricular unloading and reducing myocardial wall stress. Furthermore, early catheter ablation, guided by 3D electroanatomical mapping and advanced imaging, has proven superior to salvage procedures for stabilizing the arrhythmic substrate. Finally, the integration of palliative care ensures ethical stewardship during refractory shock. Conclusions: Modern VAs management in the CICUs represents a convergence of technology, biology, and multidisciplinary coordination.