EP News: Case Reports

Abstract

Ventricular tachycardia (VT) or ventricular fibrillation (VF) storm is a life-threatening condition that is often managed by antiarrhythmic drug therapies, catheter ablation, general anesthesia, and ventricular support devices. Radiotherapy for VT has shown early promise as a noninvasive therapy to reduce risk of recurrent VT. No data exist on the role of radiotherapy for VF storm. Scholz et al (DOI: https://doi.org/10.1016/j.hrcr.2019.03.004) shared a case of a 53-year-old man who presented with VF storm after a recent presentation with anterior myocardial infarction. Despite percutaneous intervention, the patient required a percutaneous left ventricular assist device for hemodynamic compromise. Despite this support, recurrent VF prompted the need for intubation, sedation, and venoarterial extracorporeal membrane oxygenation. The patient had recurrent VF in the setting of intensive support and after intravenous amiodarone and lidocaine. VF converted to sinus rhythm easily with defibrillation, but recurred frequently owing to triggering from monomorphic premature ventricular contractions. An ablative approach was attempted but unsuccessful. After persistence of VF on day 15, stereotactic ablative radiotherapy was performed over 30 minutes. In a stepwise manner, antiarrhythmic drug therapy and sedation were gradually withdrawn. The final arrhythmia was observed 2 weeks postradiotherapy. An implantable cardioverter-defibrillator was implanted for secondary prevention of VF/VT. This is the first report of the use of this emerging therapy for an unstable patient with recurrent VF storm after all known therapies in aggregate failed to treat the arrhythmia.