Ventricular tachycardia storm management in a COVID-19 patient: a case report
Gianfranco Mitacchione1, Marco Schiavone1, Alessio Gasperetti1
1Department of Cardiology, Luigi Sacco Hospital, University of Milan, Milan, Italy.
Insights
Coronavirus disease 2019 (COVID-19) can trigger dangerous ventricular arrhythmias and electrical storm in patients with heart conditions. This case report details a successful ablation for a patient experiencing ventricular tachycardia storm due to COVID-19.
Area of Science:
- Cardiology
- Infectious Diseases
- Electrophysiology
Background:
- Myocardial involvement is a known complication of COVID-19.
- Cardiac arrhythmias, including malignant ventricular arrhythmias and electrical storm, are potential cardiovascular manifestations.
- The specific presentation of these arrhythmias in COVID-19 patients requires further investigation.
Observation:
- A 68-year-old patient with coronary artery disease and heart failure presented with COVID-19 pneumonia.
- The patient experienced ventricular tachycardia storm with multiple implantable cardioverter defibrillator shocks as the primary cardiac manifestation.
- A successful catheter ablation using a remote navigation system was performed.
Findings:
- This is the first reported case of COVID-19 pneumonia presenting with ventricular tachycardia storm as the main cardiac manifestation.
- COVID-19 can precipitate severe ventricular arrhythmias in patients with pre-existing ischemic cardiomyopathy.
- Successful ablation provided a favorable outcome for the patient.
Implications:
- Highlights the critical need to consider cardiac arrhythmias in COVID-19 patients, especially those with underlying heart disease.
- Suggests that COVID-19 may act as a trigger for electrical storm in susceptible individuals.
- Emphasizes the efficacy of substrate-based VT ablation in managing these complex cases.
Background:
Coronavirus disease 2019 (COVID-19) has been associated with myocardial involvement. Among cardiovascular manifestations, cardiac arrhythmias seem to be fairly common, although no specifics are reported in the literature. An increased risk of malignant ventricular arrhythmias and electrical storm (ES) has to be considered.
Case Summary:
We describe a 68-year-old patient with a previous history of coronary artery disease and severe left ventricular systolic disfunction, who presented to our emergency department describing cough, dizziness, fever, and shortness of breath. She was diagnosed with COVID-19 pneumonia, confirmed after three nasopharyngeal swabs. Ventricular tachycardia (VT) storm with multiple implantable cardioverter defibrillator (ICD) shocks was the presenting manifestation of cardiac involvement during the COVID-19 clinical course. A substrate-based VT catheter ablation procedure was successfully accomplished using a remote navigation system. The patient recovered from COVID-19 and did not experience further ICD interventions.
Discussion:
To date, COVID-19 pneumonia associated with a VT storm as the main manifestation of cardiac involvement has never been reported. This case highlights the role of COVID-19 in precipitating ventricular arrhythmias in patients with ischaemic cardiomyopathy who were previously stable.
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