Stormy rhythms: unmasking the heart's electrical storm

A male in his early 70s with a history of myocardial infarction, left ventricular (LV) dysfunction and multiple comorbidities presented with palpitations and was found to have ventricular tachycardia (VT). Initial management included pharmacological cardioversion and the placement of an implantable cardioverter-defibrillator. Despite subsequent interventions, including antiarrhythmic therapy and catheter ablation, the patient developed recurrent VT originating from the LV apex, where a thrombus was present. A multidisciplinary team reviewed potential treatment options, including redo-endo and epicardial catheter ablation, stereotactic body radiotherapy, autonomic modulation and LV aneurysectomy. The patient ultimately underwent coronary artery bypass grafting with LV aneurysectomy. Postoperatively, he demonstrated significant clinical improvement, with no recurrent VT episodes and an increase in LV ejection fraction to 40% at a 10-month follow-up. This case highlights the role of ventricular aneurysectomy as a viable treatment strategy for incessant VT when medical and catheter-based interventions prove ineffective.