[Eleven-years long follow-up in a patient after myocardial infarction, with low ejection fraction and recurrent ventricular tachycardia. The role of implantable cardioverter defibrillator and selective ablation].
The selective ablation of the recurrent ventricular tachycardia (VT) in a 75-year old patient after extensive inferior myocardial infarction (24 years ago), with low ejection fraction was performed. In 1995 the cardioverter-defibrillator was implanted due to recurrent, symptomatic VT. The coronary angiography in 1995 and in 2006 revealed the occlusion of the right coronary and the circumflex arteries. One year after implantation, he had electrical storm caused by proarrhythmic effect of amiodarone with prolongation of QT/QTc interval. During follow up episodes of VT (approximately 5/year) were successfully terminated by ATP and rarely by cardioversion. Recently, the patient was admitted to the hospital because of the very frequent (25/day) episodes of slow (500-560 ms), sustained ventricular tachycardia. The pharmacological treatment was unsuccessful. CARTO mapping and entrainment pacing revealed VT circuit around mitral annulus. A few applications at the paraseptal part of the mitral isthmus terminated VT, which was no longer inducible. During following days there were no VTs requiring ICD interventions.
Przybylski
Andrzej
A
Instytut Kardiologii, ul. Alpejska 42, 04-628 Warszawa, Poland. aprzybylski@ikard.pl
Derejko
Paweł
P
Iwanek
Marta
M
Urbanek
Piotr
P
Kepski
Roman
R
Grzybowski
Jacek
J
Chojnowska
Lidia
L
Szumowski
Łukasz
Ł
Szwed
Hanna
H
Walczak
Franciszek
F
D000368:Aged; D000638:Amiodarone / Q000009:adverse effects / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use; D017115:Catheter Ablation / Q000379:methods*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications*
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone