Catheter Ablation for an Incessant Form of Antiarrhythmic Drug‐Resistant Ventricular Fibrillation After Acute Coronary Syndrome

Abstract

A 77-year-old man was admitted with an acute coronary syndrome (ACS), severe heart failure (HF), and repeated ventricular fibrillation (VF) episodes. A single premature ventricular complex (PVC) induced ventricular tachycardia (VT), which degenerated to VF reproducibly. This PVC was eliminated by catheter ablation at the left ventricular posteroseptal region where double Purkinje potentials preceding the ventricular wave had been recorded. The electrical storm disappeared, and programmable stimulation failed to induce any tachyarrhythmias after the ablation. A Purkinje fiber network-related PVC served as a trigger and as a substrate for VT and VF in a case of ACS with HF.

Venice Chart International Consensus Document on Ventricular Tachycardia/Ventricular Fibrillation Ablation

“…Most cases of VF appear to originate from the His‐Purkinje system, although some cases have initiating events that are distinct from the cardiac conduction system 244–249 . Catheter ablation of VF has been attempted in the following clinical settings: postinfarction, LQTS, Brugada syndrome, infiltrative cardiac amyloidosis, postcardiac surgery, and normal heart (idiopathic VF) 94,95,244–246,250–258 …”

“…In patients with Wolff‐Parkinson‐White syndrome, catheter ablation of the accessory pathway is clearly indicated in cases of atrial fibrillation with rapid preexcited ventricular response causing VF, or in cases with very short (<240 ms) refractory period of the accessory pathway with preexcited atrial fibrillation. Catheter ablation has been also used with success in selected patients with or without structural heart disease and with VF triggered by ventricular ectopics or Purkinje potentials 94,95,244,249,251,255,256,258,340 …”

Catheter ablation in the treatment of electrical storm: Integrative review

“…According to some authors, electrical storm (ES) can be defined as the occurrence of three or more episodes of ventricular tachycardia (VT) separated by 5 min during one day or the presence of incessant VT despite the optimization of antiarrhythmic drug therapy. Its incidence has been increasing gradually, mainly in relation to the increased indications for the use of implantable cardioverter defibrillators (ICD) as non-pharmacological therapy for severe ventricular arrhythmias and prevention of sudden cardiac death [1] , [2] , [3] , [4] , [5] , [6] , [7] .…”

Renal Sympathetic Denervation as an Adjunct to Catheter Ablation for the Treatment of Ventricular Electrical Storm in the Setting of Acute Myocardial Infarction

“…3 In patients without an implantable cardioverter/defibrillator (ICD), VS has been defined as the occurrence of 2 or more ventricular tachyarrhythmic episodes within 24 hours. 5,6 In general, VS is associated with a poor prognosis. 5,6 In general, VS is associated with a poor prognosis.…”