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Left ventricular free-wall rupture occurring during programmed ventricular stimulation in a patient with recent
J D Andress1, R S Mittleman, H Cuénoud
1Department of Medicine, University of Massachusetts Medical Center, Worcester.
Abstract:
In this report we describe a patient who died during programmed ventricular stimulation due to a rupture of the left ventricular free wall at the site of a recent myocardial infarction. The patient was a 75-year-old male who presented with an extensive anterior wall myocardial infarction complicated by sustained ventricular tachycardia occurring 8 days after admission. Cardiac catheterization revealed total occlusion of left anterior descending coronary artery and an anteroapical aneurysm. The patient died due to electromechanical dissociation during electrophysiological testing 11 days after myocardial infarction. Postmortem examination showed a rupture of the left ventricular free wall at the site of the myocardial infarction and distant from the site of catheter placement. It is suggested that caution be taken in choosing patients for electrophysiological studies who have had recent large myocardial infarctions with ventricular aneurysm.
Insights
Electrophysiological testing can be risky for patients with recent large myocardial infarctions and ventricular aneurysms. One patient died from left ventricular free wall rupture during programmed ventricular stimulation.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Pathology
Background:
- Sudden cardiac death remains a significant concern in patients with ischemic heart disease.
- Electrophysiological studies (EPS) are crucial for managing arrhythmias but carry inherent risks.
Observation:
- A 75-year-old male with extensive anterior wall myocardial infarction (MI) developed sustained ventricular tachycardia.
- Cardiac catheterization revealed left anterior descending coronary artery occlusion and an anteroapical aneurysm.
Findings:
- The patient experienced electromechanical dissociation and died during programmed ventricular stimulation.
- Postmortem examination confirmed left ventricular free wall rupture at the site of the recent MI.
Implications:
- Caution is advised when selecting patients with recent large MIs and ventricular aneurysms for EPS.
- This case highlights the potential for mechanical complications during cardiac procedures in high-risk patients.