Journal of Rare Cardiovascular Diseases

The authors report a case of a 58-year-old man with coronary artery disease and left ventricular aneurysm following inferior wall infarction, who was implanted with a single chamber cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death. The patient presented with complaints including multiple ICD shocks due to recurrent ventricular tachycardia (VT) resistant to the implemented treatment, decreased quality of life and high level of anxiety associated with multiple hospitalizations. Pharmacological treatment was unsuccessful and led to drug-induced bradycardia. Due to developed pacemaker syndrome the patient underwent ICD upgrade to a dual-chamber device followed by radiofrequency ablation. Despite a number of interventions, VT did not completely disappear. A slight decrease in the number of ICD shocks was observed. After adjustment of the pacing lower rate up to 75 bpm, ventricular arrhythmias were reduced and eventually retreated. In the six months follow-up period no VT was recorded. The authors discuss the current recommendations for VT treatment with the indications for re-ablation or aneurysmectomy. JRCD 2016; 3 (1): 20–23

rare disease; ventricular tachycardia; ventricular aneurysm; pacemaker syndrome; ablation

Friedman BM, Dunn MI. Postinfarction ventricular aneurysms. Clin Cardiol 1995; 18: 505–511.

Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an Implantable Cardioverter–Defibrillator for Congestive Heart Failure. N Engl J Med 2005; 352: 225–223.

Sears S, Todaro J, Lewis TS, et al. Examining the psychosocial impact of implantable cardioverter defibrillators: A review of literature. Clin Cardiol 1999; 7: 481–489.

Wathen MS, DeGroot DJ, Sweeney MO, et al. Prospective Randomized Multicenter Trial of Empirical Antitachycardia Pacing Versus Shocks for Spontaneous Rapid Ventricular Tachycardia in Patients With Implantable Cardioverter-Defibrillators Pacing Fast Ventricular Tachycardia Reduces Shock Therapies (PainFREE Rx II) Trial Results. Circulation 2004; 110: 2591–2596.

Fogoros RN, Fiedler SB, Elson JJ. The Automatic Implantable Cardioverter-Defibrillator in Drug-Refractory Ventricular Tachyarrhythmias. Ann Intern Med 1987; 107: 635–641.

Zipes DP, Camm AJ, Borggrefe M, et al. American College of Cardiology, American Heart Association Task Force, European Society of Cardiology Committee for Practice Guidelines: ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 2006; 48: e247-e346.

Nayyar S, Ganesan AN, Brooks AG, et al. Venturing into ventricular arrhythmia storm: a systematic review and meta-analysis. Eur Heart J 2013; 34: 560–569.

Reddy VY, Reynolds MR, Neuzil P, et al. Prophylactic catheter ablation for the prevention of defibrillator therapy. N Engl J Med 2007; 357: 2657–2665.

Willems S, Borggrefe M, Shenasa M, et al. Radiofrequency Catheter Ablation of Ventricular Tachycardia Following Implantation of an Automatic Cardioverter Defibrillator. Pacing Clin Electrophysiol 1993; 16: 1684–1692.

Reddy VY, Reynolds MR, Neuzil P, et al. Prophylactic Catheter Ablation for the Prevention of Defibrillator Therapy. N Engl J Med 2007; 357: 2657–2665.

SippensGroenewegen A, Spekhorst H, van Hemel NM, et al. Localization of the site of origin of postinfarction ventricular tachycardia by endocardial pace mapping. Body surface mapping compared with the 12–lead electrocardiogram. Circulation 1993; 88: 2290–2306.

Coltharp WH, Hoff SJ, Stoney WS. Ventricular Aneurysmectomy. A 25-year experience. Ann Surg 1994; 219: 707–714.

Dor V, Sabatier M, Di Donato M, et al. Late hemodynamic results after left ventricular patch repair associated with coronary grafting in patients with postinfarction akinetic or dyskinetic aneurysm of the left ventricle. J Thorac Cardiovasc Surg 1995; 110: 1291–301.

Wellens F, Geelen P, Demirsoy E, et al. Surgical treatment of tachyarrhythmias due to postinfarction left ventricular aneurysm with endoaneurysmorrhaphy and cryoablation. Eur J Cardiothorac Surg 2002; 22: 771–776.

Velebit V, Podrid P, Lown B, et al. Aggravation and provocation of ventricular arrhythmias by antiarrhythmic drugs. Circulation 1982; 65: 886–894.

Modary F, Sauve MJ, Malone P, et al. Long-term efficacy and toxicity of high-dose amiodarone therapy for ventricular tachycardia or ventricular fibrillation. Tam J Cardiol 1983; 52: 975–979.

Heldman D, Mulvihill D, Nguyen H, et al. True Incidence of Pacemaker Syndrome. Pacing Clin Electrophysiol 1990; 13: 1742–1750.

Anderson JL, Mason JW. Successful treatment by overdrive pacing of recurrent quinidine syncope due to ventricular tachycardia. Am J Med. 1978; 64: 715–718.

Ritchie JL, Hammermeister KE, Kennedy JW. Refractory ventricular tachycardia and fibrillation in a patient with the prolapsing mitral leaflet syndrome: Successful control with overdrive pacing. Am J Cardiol 1976; 37: 314–316.