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Case Reports
. 2021 May 17;15(1):243.
doi: 10.1186/s13256-021-02833-2.

Effective treatment of electrical storm by a wearable cardioverter defibrillator in a patient with severely impaired left ventricular function after myocardial infarction: a case report

Henrike Andresen  1 , B Sasko  2 , D Patschan  2 , N Pagonas  2 , O Ritter  2
Affiliations
Case Reports

Effective treatment of electrical storm by a wearable cardioverter defibrillator in a patient with severely impaired left ventricular function after myocardial infarction: a case report

Henrike Andresen et al. J Med Case Rep. .

Abstract

Background: The implantation of cardioverter defibrillators (ICDs) is an established therapy in the prevention of sudden cardiac death in patients with systolic dysfunction after myocardial infarction. To avoid immediate implantation of an ICD, wearable cardioverter defibrillator vests (WCD) can be used to protect patients against malignant rhythm disorders, while at the same time drug-based heart failure therapy has to be initiated. This drug therapy can improve left ventricular ejection fraction and primary prophylactic cardioverter defibrillator implantation may not be necessary. However, the recent Vest Prevention of Early Sudden Death Trial (VEST) questioned the regular use of the WCD in this setting.

Case presentation: A 47-year-old Caucasian man with severely impaired left ventricular function early after myocardial infarction was prescribed a WCD as primary prophylaxis to prevent sudden cardiac death. Seven days after the patient was supplied with a WCD, the patient suffered from an electrical storm with recurrent ventricular tachycardia (VT), which was successfully terminated 17 times by the WCD. On coronary angiography, the formerly infarct-related right coronary artery had TIMI (Thrombolysis in Myocardial Ischemia Trial) III flow, and a remaining stenosis in the left anterior descending artery (LAD) was stented, which did not stop recurrent VT. In the electrophysiology (EP) study, a focus was mapped in the left inferior ventricle, which was ablated. This stopped the VT. A second radio-frequency (RF) ablation in the same area was necessary after 14 days. Finally, a permanent cardioverter defibrillator was implanted.

Conclusion: We report the case of a patient who survived recurrent episodes of VT early after myocardial infarction by effective defibrillation with a WCD. The WCD is a useful device to bridge time until a final decision for implantation of a defibrillator.

Keywords: Electrical storm; Post-myocardial infarction; Ventricular tachycardia; Wearable cardioverter defibrillator.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Coronary angiography. a Total occlusion of the right coronary artery (RCA) (left anterior oblique [LAO] view). Coronary angiography after stent implantation: b angiography of the RCA (LAO view)
Fig. 2
Fig. 2
Electrocardiogram recorded ventricular tachyarrhythmia. Ventricular tachyarrhythmia is terminated by a shock 36 seconds later and subsequent sinus rhythm
Fig. 3
Fig. 3
Torsade de pointes
Fig. 4
Fig. 4
Twelve lead electrocardiogram demonstrating ventricular bigeminy
See this image and copyright information in PMC

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