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Ventricular Tachycardia Storm After Standard Radiofrequency Pulmonary Vein Isolation.
Am J Case Rep 2019; 20:1536-1539AJ

Abstract

BACKGROUND

The occurrence of ventricular arrhythmias (VAs), particularly premature ventricular complexes, following pulmonary vein isolation (PVI) is a documented phenomenon, but monomorphic scar-related ventricular tachycardia (VT) following PVI is an unusual phenomenon. In this case report, we present a case of new-onset VA after radiofrequency PVI in a patient with no prior history of sustained VTs. CASE REPORT Our patient was a 69-year-old man with a history of symptomatic persistent atrial fibrillation, with an apparently structurally normal heart with subtle regional wall motion abnormalities. He underwent radiofrequency directed pulmonary vein isolation ablation. On the night of an uneventful procedure, the patient for the first time experienced a sustained ventricular tachycardia that exacerbated into a VT storm. Each arrhythmia was terminated by cardioversion due to hemodynamic instability. Antiarrhythmic treatment with lidocaine was initiated immediately. The patient settled from sustained ventricular arrhythmia and received further ablation to monomorphic ventricular tachycardia.

CONCLUSIONS

The incidence of ventricular ectopics after PVI ablation has been previously described, but a sustained monomorphic ventricular storm has not been reported before with RF ablation. We attribute the pathophysiology to an increase in myocardial excitability and/or ventricular autonomic modulation. This is a very rare phenomenon, but any subtle imaging abnormality before planning RF-PVI should be taken into consideration.

Authors+Show Affiliations

Heart and Vascular Center, Mater Private Hospital, Dublin, Ireland.Heart and Vascular Center, Mater Private Hospital, Dublin, Ireland.Cardiology Department, Medina Cardiac Center, Medina, Saudi Arabia.Heart and Vascular Center, Mater Private Hospital, Dublin, Ireland.Heart and Vascular Center, Mater Private Hospital, Dublin, Ireland.Heart and Vascular Center, Mater Private Hospital, Dublin, Ireland.Heart and Vascular Center, Mater Private Hospital, Dublin, Ireland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31628298

Citation

Boles, Usama, et al. "Ventricular Tachycardia Storm After Standard Radiofrequency Pulmonary Vein Isolation." The American Journal of Case Reports, vol. 20, 2019, pp. 1536-1539.
Boles U, Refila B, Gul EE, et al. Ventricular Tachycardia Storm After Standard Radiofrequency Pulmonary Vein Isolation. Am J Case Rep. 2019;20:1536-1539.
Boles, U., Refila, B., Gul, E. E., Szeplaki, G., Keaney, J., Galvin, J., & Keelan, E. (2019). Ventricular Tachycardia Storm After Standard Radiofrequency Pulmonary Vein Isolation. The American Journal of Case Reports, 20, pp. 1536-1539. doi:10.12659/AJCR.918432.
Boles U, et al. Ventricular Tachycardia Storm After Standard Radiofrequency Pulmonary Vein Isolation. Am J Case Rep. 2019 Oct 19;20:1536-1539. PubMed PMID: 31628298.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ventricular Tachycardia Storm After Standard Radiofrequency Pulmonary Vein Isolation. AU - Boles,Usama, AU - Refila,Beshoy, AU - Gul,Enes E, AU - Szeplaki,Gabor, AU - Keaney,John, AU - Galvin,Joseph, AU - Keelan,Edward, Y1 - 2019/10/19/ PY - 2019/10/20/entrez PY - 2019/10/20/pubmed PY - 2019/10/20/medline SP - 1536 EP - 1539 JF - The American journal of case reports JO - Am J Case Rep VL - 20 N2 - BACKGROUND The occurrence of ventricular arrhythmias (VAs), particularly premature ventricular complexes, following pulmonary vein isolation (PVI) is a documented phenomenon, but monomorphic scar-related ventricular tachycardia (VT) following PVI is an unusual phenomenon. In this case report, we present a case of new-onset VA after radiofrequency PVI in a patient with no prior history of sustained VTs. CASE REPORT Our patient was a 69-year-old man with a history of symptomatic persistent atrial fibrillation, with an apparently structurally normal heart with subtle regional wall motion abnormalities. He underwent radiofrequency directed pulmonary vein isolation ablation. On the night of an uneventful procedure, the patient for the first time experienced a sustained ventricular tachycardia that exacerbated into a VT storm. Each arrhythmia was terminated by cardioversion due to hemodynamic instability. Antiarrhythmic treatment with lidocaine was initiated immediately. The patient settled from sustained ventricular arrhythmia and received further ablation to monomorphic ventricular tachycardia. CONCLUSIONS The incidence of ventricular ectopics after PVI ablation has been previously described, but a sustained monomorphic ventricular storm has not been reported before with RF ablation. We attribute the pathophysiology to an increase in myocardial excitability and/or ventricular autonomic modulation. This is a very rare phenomenon, but any subtle imaging abnormality before planning RF-PVI should be taken into consideration. SN - 1941-5923 UR - https://www.unboundmedicine.com/medline/citation/31628298/Ventricular_Tachycardia_Storm_After_Standard_Radiofrequency_Pulmonary_Vein_Isolation L2 - https://www.amjcaserep.com/download/index/idArt/918432 DB - PRIME DP - Unbound Medicine ER -