Ventricular tachycardic storm with a chronic total coronary artery occlusion treated with percutaneous coronary...

Area of Science:

• Cardiology
• Interventional Cardiology
• Electrophysiology

Background:

• Ventricular tachycardia (VT) storm poses a significant clinical challenge, often refractory to medical management.
• Coronary artery disease, particularly chronic total occlusion (CTO), is an under-recognized potential trigger for refractory ventricular arrhythmias.
• Identifying and treating underlying ischemic causes is crucial for managing complex ventricular arrhythmias.

Observation:

• A 66-year-old male with coronary artery disease experienced recurrent VT storm despite antiarrhythmic drug therapy (amiodarone, lidocaine).
• The patient had a chronic total occlusion of the right coronary artery, suspected as the ischemic trigger for VT.
• Percutaneous coronary intervention (PCI) successfully treated the CTO, followed by implantable cardioverter-defibrillator (ICD) implantation.

Findings:

• Following PCI of the CTO and ICD implantation, the patient experienced complete resolution of VT storm during hospitalization.
• At 9-month follow-up, the patient remained free of chest pain and recurrent ischemia, with only brief, nonsustained VT episodes noted on ICD interrogation.
• No shocks were delivered by the ICD, indicating sustained VT suppression.

Implications:

• Successful PCI of CTO in the context of VT storm suggests a direct causal link between chronic ischemia and ventricular arrhythmia provocation.
• This case supports revascularization of CTO as a therapeutic strategy in selected patients with refractory ventricular arrhythmias.
• Further research is warranted to elucidate the mechanisms and confirm the efficacy of CTO intervention for managing VT storm.