Coronary heart disease patient with implantable cardioverter desfibrilator and electrical storm submitted to ventricular tachycardia ablation

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Coronary heart disease patient with implantable cardioverter desfibrilator and electrical storm submitted to ventricular tachycardia ablation

Nilton José Carneiro da Silva^I; Bruno Pereira Valdigem^I; Christian Luize^II; Fernando Lopes Nogueira^II; Claudio Cirenza^III; Guilherme Fenelon^III; Marcia Regina Pinho Makdisse^I; Fátima Dumas Cintra^III; Angelo Amato Vincenzo De Paola^III

^IHospital Israelita Albert Einstein - HIAE, Sao Paulo (SP), Brazil

^IIUniversidade Federal de São Paulo - UNIFESP, São Paulo (SP), Brazil

^IIIUniversidade Federal de São Paulo - UNIFESP, São Paulo (SP), Brazil; Hospital Israelita Albert Einstein - HIAE, São Paulo (SP), Brazil

^{Corresponding author}

A 69-year old diabetic patient with O₂-dependent chronic obstructive pulmonary disease (COPD), history of myocardial revascularization in 1998 and one episode of ventricular tachycardia and placement of cardiac defibrillator in 2003. He was seen at the Emergency Department in February 2010 with palpitations and four shocks in the last two hours. The electrocardiogram showed wide QRS tachycardia with right bundle branch block (RBB) and superior axis (Figure 1). Arrhythmia reverted after sedation and eletrical cardioversion (ECV). The implantable cardioverter defibrillator (ICD) evaluation demonstrated appropriate therapy (shock for ventricular tachycardia), confirming the main hypothesis (Figure 2). He presented recurrence of tachycardia despite the optimized drug treatment, including intravenous amiodarone. The use of the antitachycardia pacing (ATP) (fast stimuli) through the ICD did not stop tachycardia; on the contrary, it would even increase it. Hence the patient was submitted to catheter ablation of ventricular tachycardia. Since there was more than one inducible tachycardia episode, and the patient did not tolerate arrhythmia for a prolonged period, it was decided to perform combined ablation of the arrhythmic substrate, guided by the electroanatomical map (CARTO) (Figure 3) to assist with electrophysiological data (Figure 4). The procedure was successful and there have been no new ventricular tachycardia episodes in clinical follow-up.

The use of the electroanatomical map in electrophysiological procedures enabled managing complex arrhythmias in patients at high pre-procedure risk ⁽¹⁾. Atrial fibrillation and ventricular tachycardia related to structural cardiopathy have been addressed with this technology in most specialized centers, showing superior results than the conventional technique^(2-3).

Received on: Feb 28, 2011

Accepted on: Feb 12, 2012

References

• 1. Aliot EM, Stevenson WG, Almendral-Garrote JM. EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). Heart Rhythm. 2009;6(6):886-933.
• 2. Hsia HH, Lin D, Sauer WH, Callans DJ, Marchlinski FE. Anatomic characterization of endocardial substrate for hemodynamically stable reentrant ventricular tachycardia: identification of endocardial conducting channels. Heart Rhythm. 2006;3(5):503-12.
• 3. Soejima K, Suzuki M, Maisel WH, Brunckhorst CB, Delacretaz E, Blier L, et al. Catheter ablation in patients with multiple and unstable ventricular tachycardias after myocardial infarction: short ablation lines guided by reentry circuit isthmuses and sinus rhythm mapping. Circulation. 2001;104(6):664-9.

Publication Dates

• Publication in this collection
  19 Sept 2012
• Date of issue
  Mar 2012