More safety with more energy: survival of electrical storm with 40-J shocks.

We report the first clinical case of ineffective high-voltage therapy with 36 J and subsequent effective therapy with 40 J in a patient with electrical storm who had previously received a high-energy implantable cardioverter defibrillator (ICD, Fortify VR, 1233-40Q St. Jude Medical, Sylmar, CA, USA). Using a combination of high energy and optimized fixed millisecond duration biphasic waveform shock, successful defibrillation could be achieved at 8 J below the programmed maximum energy level.