Electrical storm in pregnancy uncovering an arrhythmogenic cardiomyopathy: a case report

Pregnancy involves numerous physiological changes in the cardiovascular system to guarantee foetal metabolic demands. In patients with cardiovascular disease, these adaptations can decompensate their underlying condition, leading to maternal and obstetric complications.We report a case of arrhythmogenic cardiomyopathy presenting as an electrical storm during pregnancy, highlighting both diagnostic and management challenges.

A 35-year-old pregnant woman at 18 weeks of gestation presented with an electrical storm, experiencing multiple episodes of sustained ventricular tachycardia. Diagnostic tests, including a non-contrast cardiac magnetic resonance, were suggestive of biventricular arrhythmogenic cardiomyopathy. After a multidisciplinary team discussion, the patient was treated with antiarrhythmic agents, and an implantable cardioverter-defibrillator was implanted. She was discharged after 10 days, and a delivery plan was made for a scheduled induction at 38 weeks, which proceeded without complications. Genetic testing revealed a desmoplakin (DSP) mutation, further supporting the diagnosis.

Pregnancy can precipitate arrhythmic events, particularly in women with underlying cardiovascular disease. This case illustrates how pregnancy-induced haemodynamic stress may trigger previously undiagnosed cardiomyopathy. Management of such cases requires a multidisciplinary approach, adherence to clinical guidelines, and careful balancing of maternal and foetal risks. The patient's successful management, including guided antiarrhythmic therapy and device implantation with minimal radiation exposure, highlights the importance of individualized care and the role of a dedicated cardio-obstetrics team.