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[Life-threatening ventricular tachyarrhythmia after CABG in a patient with poor LV function--an experience with the
Y Yoshikawa1, S Taniguchi, T Kawata
1Department of Surgery III, Nara Medical College, Japan.
Insights
A patient with reduced heart function experienced severe ventricular tachycardia after heart surgery. Amiodarone and an implantable defibrillator were crucial in managing this life-threatening arrhythmia.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- A 52-year-old male presented with reduced left ventricular function (ejection fraction 0.27) post-myocardial infarction.
- Underwent coronary artery bypass grafting (CABG) for angina pectoris.
Observation:
- Developed recurrent sustained ventricular tachycardia (VT) 5 hours post-CABG.
- VT proved resistant to multiple antiarrhythmic drugs (Lidocaine, Mexiletine, Disopyramide, Procainamide, Propafenone).
- Required mechanical circulatory support (IABP, PCPS) and 441 cardioversions over 18 days due to refractory VT.
Findings:
- Amiodarone administration successfully suppressed VT episodes.
- Recurrent VT on exertion necessitated the implantation of a cardioverter-defibrillator (ICD).
- Successful patient discharge occurred 134 days post-CABG, with ICD function confirmed.
Implications:
- Highlights the challenges in managing post-CABG ventricular tachycardia.
- Demonstrates the efficacy of Amiodarone and ICD implantation in refractory cases.
- Emphasizes the importance of advanced hemodynamic support and arrhythmia management strategies.
Abstract:
A 52-year-old man with reduced left ventricular function (ejection fraction 0.27) due to myocardial infarction, underwent coronary artery bypass grafting (CABG; LITA-LAD, free RITA-4PD) for angina pectoris. He had suffered from recurrent sustained ventricular tachycardia (VT) since 5 hours after CABG. This arrhythmia was resistant to various antiarrhythmic agents such as Lidocaine, Mexiletine, Disopyramide, Procainamide and Propafenone. He required mechanical circulatory supports (intra-aortic balloon pumping and percutaneous cardiopulmonary support) for the maintenance of hemodynamics during repeated VT that required cardioversions of a total of 441 times during 18 days. Following the administration of Amiodarone, the VT was successfully suppressed. However, he had repeated episodes of VT on exercise, thus, he underwent insertion of the implantable cardioverter-defibrillator at the 98 post-operative day, and he was successfully discharged at the 134 post-operative day after CABG. The instrument was verified to be normal in function after the VT induction test.