Bidirectional Ventricular Tachycardia Culminating in Cardiac Arrest: A Diagnostic and Management Conundrum
Saurabh V Limaye1, Abhinav B Anand2, Pratap J Nathani3
1Assistant Professor, Department of Cardiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Mahrashtra, India, Corresponding Author.
None:
Bidirectional ventricular tachycardia (BDVT) is a rare arrhythmia marked by beat-to-beat QRS axis alteration. We report a 36-year-old female with recurrent palpitations who presented with BDVT degenerating into polymorphic ventricular tachycardia and ventricular fibrillation. An extensive evaluation, including cardiac magnetic resonance imaging (MRI), stress and adrenaline provocation testing, and a comprehensive genetic arrhythmia panel, revealed no definitive etiology. Given the concern for proarrhythmic implantable cardioverter-defibrillator (ICD) shocks in a potential channelopathy and after shared decision-making, the patient was managed with high-dose beta blocker therapy. This case underscores the diagnostic and management challenges of BDVT in a structurally normal heart, particularly when balancing guideline recommendations against individualized patient factors.
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