• defibrillation—ICD;
  • electrophysiology—clinical;
  • pacing;
  • imaging

We report a 43-year-old man with an implantable cardioverter defibrillator for aborted sudden cardiac death. He represents in extreme electrical storm with 111 different ventricular fibrillation episodes. Successful treatment was achieved with multiple antiarrhythmic agents, mechanical ventilation, external shocks, and ultimately overdrive pacing. A cardiac magnetic resonance scan revealed two cardiac lesions that were later diagnosed as metastatic fibrosarcoma. This case highlights two very important and increasingly common cardiological dilemmas: the management of extreme electrical storm and the role of magnetic resonance imaging in aborted cardiac death patients with an apparent “normal” heart.