Mid-septal hypertrophy and apical ballooning; potential mechanism of ventricular tachycardia storm in patients with hypertrophic cardiomyopathy

Eui Seock Hwang, Hui Nam Pak

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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 β-blockade, hydration, and sedation. VT spontaneously stopped 1.5 hours later and the patient has remained free of VT for 24 months with β-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.

Original languageEnglish
Pages (from-to)221-223
Number of pages3
JournalYonsei medical journal
Volume53
Issue number1
DOIs
Publication statusPublished - 2012 Jan 1

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Hypertrophic Cardiomyopathy
Ventricular Tachycardia
Hypertrophy
Catheter Ablation
Implantable Defibrillators
Hemodynamics
Heart Ventricles
Shock
Anti-Arrhythmia Agents
Tachycardia

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

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