Korean Circ J.  2008 Jan;38(1):60-65. 10.4070/kcj.2008.38.1.60.

Electrical Storm Late after Surgery for a Double-Chambered Right Ventricle, Aortic Regurgitation and a Ventricular Septal Defect: A Case of Successful Catheter Ablation

• Kim J
• Park TI
• An SG
• Lee HC
• Kim JH
• Chun KJ
• Hong TJ
• Shin YW

• KMID: 2225875
• DOI: http://doi.org/10.4070/kcj.2008.38.1.60

Abstract

An electrical storm is defined as multiple occurrences of ventricular tachycardia/fibrillation (VT/VF) within a single day; this is a medical emergency and a poor prognostic marker in patients with an implantable cardioverter-defibrillator (ICD). We report here on the occurrence of electrical storms in a 35-year-old man with a repaired DCRV and ICD. He had recurrent VT and electrical storms that were refractory to amiodarone and beta-blocker. A cardiac electrophysiologic study was performed 11 months after the ICD was implanted and two forms of VT were induced. After the catheter ablation of the VTs, the monomorphic VT became non-inducible. The frequency of the VT decreased from 35 per month before the catheter ablation to 1.1 times per month after the procedure. Catheter ablation of VT could be an effective treatment for patients with electrical storms refractory to antiarrhythmic drugs.

Keyword

Ventricular tachycardia; Catheter ablation

MeSH Terms

Adult
Amiodarone
Anti-Arrhythmia Agents
Aortic Valve Insufficiency
Catheter Ablation
Catheters
Defibrillators, Implantable
Electrophysiologic Techniques, Cardiac
Emergencies
Heart Ventricles
Humans
Tachycardia, Ventricular
Amiodarone
Anti-Arrhythmia Agents

Figure

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  Fig. 1 Standard 12-lead electrocardigrams at a paper speed of 25 mm/s. Ventricular tachycardia (A). Sinus rhythm (B).

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  Fig. 2 Clinical course of the patient. The upper panel summarizes the daily dose (mg) of amiodarone and lower graph summarizes the monthly episodes of ventricular tachycardia (VT) after the implantation of the ICD. After the catheter ablation of the VT, the frequency of the VT episodes markedly decreased from 35 to 1.1 per month. ICD: implantable cardioverter-defibrillator.

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  Fig. 3 Stored electrograms from episodes of ventricular tachycardia (VT). Electrogram from true ventricular bipole, marker channel, and electrogram from ICD can to ring were arranged from top to bottom. There was sudden rate acceleration and configuration change of ventricular electrograms, which were consistent with VT. Upon detection of VT, antitachycardia pacing (ATP) began. However, VT did not terminated by the first ATP (A). The second ATP terminated VT (B). ICD: implantable cardioverter-defibrillator.

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  Fig. 4 Intracardiac electrogram and fluoroscopic images during electrophysiological study. Twelve-lead electrocardiograms of induced ventricular tachycardias by programmed electrical stimulation at a paper speed of 25 mm/s (A, B) and the corresponding pace-maps of each ventricular tachycardia (C, D). Corresponding fluoroscopic images of the ablation catheter at the best pace-map site in the left anterior oblique view (E, F). The arrows in E and F indicate the mechanical aortic valve. The abbreviations are as follows. ABL: ablation catheter, ICD lead: defibrillator lead positioned in the right ventricle, RVA: catheter in the right ventricular apex, RVOT: catheter in the right ventricular outflow tract. ICD: implantable cardioverter-defibrillator.

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