Refractory ventricular tachycardia: clinical challenges and management strategies

This case report highlights the clinical course of a young patient with a history of ischaemic cardiomyopathy and severely impaired left ventricular (LV) systolic function following a delayed anterior myocardial infarction, which was further complicated by the presence of large LV thrombus. The patient subsequently presented with persistent ventricular tachycardia (VT) refractory to multiple anti-arrhythmic medications and antitachycardia pacing (ATP). VT ablation was contraindicated due to the LV thrombus, and the failure of conventional medical therapy. Heart transplantation was considered as the final viable management strategy. This case highlights the complexity of managing patients with advanced heart failure and ventricular arrhythmias, emphasising the importance of timely consideration of advanced therapeutic options in refractory scenarios.