Electrical Storm in Advanced Chagas Cardiomyopathy Treated With Stereotactic Arrhythmia Radiotherapy After LVAD Implantation
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Updated: Nov 1, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Pranav Bhagirath1, Gabriela Antelo2, Raimondo Pittorru3
1Hospital Clínic de Barcelona, Institut Clínic Cardiovascular, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
Background:
Refractory ventricular tachycardia (VT) in advanced Chagas cardiomyopathy remains challenging after prior ablation and mechanical circulatory support.
Case Summary:
A 40-year-old man with advanced Chagas cardiomyopathy and prior endo-epicardial VT ablation developed electrical storm during influenza A infection and underwent left ventricular assist device implantation as a bridge to transplantation. Despite unloading, antiarrhythmic therapy, overdrive pacing, and stellate ganglion modulation, monomorphic VT persisted. Repeat ablation was unfavorable because of frailty and extensive residual lateral scar. Targeting for stereotactic arrhythmia radiotherapy (STAR) integrated late gadolinium enhancement cardiac magnetic resonance, clinical VT morphology, prior electroanatomic mapping, and planning computed tomography. A single 25-Gy fraction was delivered without acute complications. No sustained VT or implantable cardioverter-defibrillator shocks occurred during follow-up.
Discussion:
Multimodality-guided STAR was feasible in this critically ill left ventricular assist device-supported patient. Although stabilization cannot be attributed to STAR alone, radiotherapy was delivered without observed acute radiotherapy- or device-related complications.
Take-Home Message:
STAR may offer a noninvasive substrate-targeted option when repeat ablation is limited.
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