Electrical storm after percutaneous coronary intervention for subacute anterior myocardial infarction with heart...

Electrical storm (ES) following acute coronary syndrome is rare but often fatal. A man in his early 70s experienced syncope and dyspnoea while playing golf, approximately 2 weeks after experiencing back pain. He was diagnosed with subacute anterior myocardial infarction based on pulmonary congestion, abnormal anterior wall movement and negative T waves in the precordial leads. Percutaneous coronary intervention with drug-eluting stent implantation was performed from the left main trunk to the proximal left anterior descending artery. On days 4-5 of hospitalisation, he developed recurrent ventricular fibrillation (VF) consistent with ES. High-rate pacing, deep sedation with mechanical ventilation and intra-aortic balloon pumping were initiated. To achieve more physiological pacing in the setting of severe left ventricular dysfunction, a coronary sinus lead was placed; however, ES developed shortly after catheter placement and required veno-arterial extracorporeal membrane oxygenation. Continuous VF, unresponsive to multiple direct current shocks, was finally terminated by direct-current shock after landiolol administration. Subsequent percutaneous stellate ganglion blocks stabilised the arrhythmia, allowing successful weaning from mechanical circulatory support.