Idiopathic left ventricular aneurysm associated with pleomorphic ventricular tachycardia: a case report

A 39-year-old Japanese woman presented with an idiopathic left ventricular aneurysm manifesting as recurrent episodes of palpitation. She was referred to our hospital for evaluation of sustained ventricular tachycardia. Echocardiography disclosed a dyskinetic well-defined wall bulge during both systole and diastole at the basal region of the interventricular septum, and reduced left ventricular wall thickness and severe hypokinesis at the anterolateral to posterolateral region. These appearances were confirmed by the angiographic findings. The sustained ventricular tachycardia was reproducibly induced by a single extrastimulus from the right ventricular apex. Subsequently, 4-type ventricular tachycardias were induced during the electrophysiological study and the mechanism of these ventricular tachycardias was considered reentry. Radiofrequency catheter ablation failed due to the changing QRS morphologies during the entrainment study. The patient was treated with cibenzoline 300 mg a day, and there has been no recurrence of tachycardia during the 18-month follow-up period.