Mid-Septal Hypertrophy and Apical Ballooning; Potential Mechanism of Ventricular Tachycardia Storm in Patients with Hypertrophic Cardiomyopathy
Yonsei Medical Journal
; : 221-223, 2012.
Article
ي En
| WPRIM
| ID: wpr-145828
المكتبة المسؤولة:
WPRO
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.
Key words
النص الكامل:
1
الفهرس:
WPRIM
الموضوع الرئيسي:
Cardiomyopathy, Hypertrophic
/
Cardiac Catheterization
/
Gated Blood-Pool Imaging
/
Tachycardia, Ventricular
/
Catheter Ablation
/
Electrocardiography
/
Takotsubo Cardiomyopathy
المحددات:
Humans
/
Male
اللغة:
En
مجلة:
Yonsei Medical Journal
السنة:
2012
نوع:
Article