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Ventricular Tachycardia Storm in Young Women with
Implantable Cardioverter Defibrillator, what should we do ? : A Case Report
Putri Mardhatillah, * Hauda El Rasyid *, Yoga Yuniadi **
Electrophysiologi and Pacing Division
Departement of Cardiology and Vascular Medicine
* Faculty of Medicine Andalas University / General Hospital Dr. M. Djamil Padang
**Faculty of Medicine Indonesia University / National Cardiac Centre Harapan Kita Jakarta
Introduction. The incidence of electrical storm esp Ventricular Tachycardia (VT) was lower
in patient with Implantable Cardioverter Defibrillator (ICD). If reprogrammed ICD and
optimal anti arrhytmias drugs (AAD) alredy done but storm VT sill continued, an underlying
cause include channelopathy arrhytmias must be warrant. Aggressive management should be
done to improve prognosis.
Case ilustration. A-45 years old female was hospitalized caused by 3 times ICD shock since
3 hours before admitted. Ventricular tachycardia with cycle lengt (CL) 290-280 ms
terminated by ICD (anti tachycardia pacing, ATP 3x35 joule). Since day 2 hospitalized there
were storm VT with one episodes of torsade de pointes, fortunately terminated by ICD.
Electrolites, coronary angiography were normal. Echocardiography showed low ejection
fraction with global hipokinetik abnormality (similar with previous echocardiography).
Almost all VT preceded by PVC that mimicking mitral annulus or RVOT postero septal
origin. She got intra venous xylocain, metoprolol orally and heart failure management. At
day 9 no ventricular arrhytmias at all, then she was transferred for catheter ablation. There
were more than 5 VT morphologies indicating from mitral annulus anterolateral LVOT
(endocardial) and anterolateral mitral annulus (epicardial) origin. Not all VT can be ablated.
Until six months later, no more VT episode. From electrocardiography (ECG) QTc was
shortened.
Discussion. This patient got ICD for secondary prevention after suffered syncope due to
long QT syndrome (LQTS) 3 years before. No ICD shock until this storm VT.
Reprogrammed ICD and AAD was given, but storm VT still occured. An underlying cause
such as idiopathic VT was thought. From 3D mapping during ablation, there was a large VT
scar. Endocardial and epicardial ablation could not ablate all VT morphologiest but
symptoms improve. Idealy magnetic resonance imaging (MRI) should be performed for
definite diagnose, unfortunatelly could not be done. Arrhytmogenic right ventricular disease
may be an underlying disease in this case. Prognosis of this patient is poor. Heart
transplantation is the best choice.
Key words: storm ventricular tachycardia, Implantable Cardioverter Defibrillator, ablation,