Stormy rhythms: unmasking the heart's electrical storm

Area of Science:

• Cardiology
• Cardiac Surgery
• Electrophysiology

Background:

• A 70-year-old male with a history of myocardial infarction and left ventricular (LV) dysfunction presented with ventricular tachycardia (VT).
• Initial treatments including cardioversion, implantable cardioverter-defibrillator, antiarrhythmic drugs, and catheter ablation failed to resolve recurrent VT originating from the LV apex.
• A thrombus was identified at the LV apex, complicating the VT substrate.

Purpose of the Study:

• To evaluate the efficacy of ventricular aneurysectomy as a treatment for incessant VT in a patient with complex cardiac history.
• To explore surgical intervention when medical and catheter-based therapies are insufficient.

Main Methods:

• A multidisciplinary team considered various treatment options, including advanced ablation techniques, radiotherapy, and autonomic modulation.
• The patient underwent coronary artery bypass grafting combined with LV aneurysectomy.
• Postoperative follow-up included clinical assessment and echocardiography.

Main Results:

• The patient experienced significant clinical improvement following surgery.
• No recurrent VT episodes were observed during a 10-month follow-up period.
• Left ventricular ejection fraction increased to 40% postoperatively.

Conclusions:

• Ventricular aneurysectomy, in conjunction with coronary artery bypass grafting, is a viable and effective treatment for incessant VT.
• Surgical resection of the ventricular aneurysm successfully addressed the VT source when other methods failed.
• This case underscores the importance of considering surgical options for refractory VT associated with LV abnormalities.