Mid-Septal Hypertrophy and Apical Ballooning; Potential Mechanism of Ventricular Tachycardia Storm in Patients with Hypertrophic Cardiomyopathy.
10.3349/ymj.2012.53.1.221
- Author:
Eui Seock HWANG
1
;
Hui Nam PAK
Author Information
1. Department of Cardiology, Yonsei University Health System, Seoul, Korea. hnpak@yuhs.ac
- Publication Type:Case Reports ; Research Support, Non-U.S. Gov't
- Keywords:
Catheter ablation;
radiofrequency;
electrical storm;
ventricular tachycardia;
hypertrophic cardiomyopathy
- MeSH:
Cardiomyopathy, Hypertrophic/complications/diagnosis/*physiopathology/therapy;
Catheter Ablation;
Electrocardiography;
Gated Blood-Pool Imaging;
Heart Catheterization;
Humans;
Male;
Middle Aged;
Tachycardia, Ventricular/diagnosis/etiology/*physiopathology/therapy;
Takotsubo Cardiomyopathy/complications/diagnosis/*physiopathology/therapy
- From:Yonsei Medical Journal
2012;53(1):221-223
- CountryRepublic of Korea
- Language:English
-
Abstract:
Medically refractory ventricular tachycardia (VT) storm can be controlled with radiofrequency catheter ablation (RFCA), however, it may be difficult to control in some patients with hemodynamic overload. We experienced a patient with intractable VT storm controlled by hemodynamic unloading. The patient had mid-septal hypertrophic cardiomyopathy with an implantable cardioverter defibrillator (ICD) back-up. Because of the severe mid-septal hypertrophy, his left ventricle (LV) had an hourglass-like morphology and showed apical ballooning; the focus of VT was at the border of apical ballooning. Although we performed VT ablation because of electrical storm with multiple ICD shocks, VT recurred 1 hour after procedure. As the post-RFCA monomorphic VT was refractory to anti-tachycardia pacing or ICD shock, we reduced the hemodynamic overload of LV with beta-blockade, hydration, and sedation. VT spontaneously stopped 1.5 hours later and the patient has remained free of VT for 24 months with beta-blockade alone. In patients with VT storm refractory to antiarrhythmic drugs or RFCA, the mechanism of mechano-electrical feedback should be considered and hemodynamic unloading may be an essential component of treatment.
