Abstract
A 63-year-old man with hypertrophic cardiomyopathy (HCM), mid-ventricular obstruction,
and an apical aneurysm had an episode of cardiac arrest due to sustained ventricular
tachycardia (VT). He was resuscitated and an implantable cardioverter-defibrillator
(ICD) was implanted. In the following years, several episodes of VT and ventricular
fibrillation were successfully terminated by antitachycardia pacing or ICD shocks.
Three years after ICD implantation, he was re-admitted because of refractory electrical
storm (ES). Since aggressive pharmacological treatments, direct current cardioversions,
and deep sedation were not effective, he underwent epicardial catheter ablation which
was successful to terminate ES. However, because of the recurrence of refractory ES
after one year, he proceeded to surgical left ventricular myectomy with apical aneurysmectomy
which provided him a relatively stable clinical course for six years. Although epicardial
catheter ablation may be an acceptable option, surgical resection of apical aneurysm
seems to be most efficacious for ES in patients with HCM and an apical aneurysm.
Learning objectives
In patients with hypertrophic cardiomyopathy (HCM), implantable cardioverter-defibrillators
(ICDs) are the gold standard of therapy for prophylaxis against sudden death. Electrical
storm (ES) caused by recurrent episodes of ventricular tachycardia can cause sudden
death even in patients with ICDs. Although epicardial catheter ablation may be an
acceptable option, surgical resection of apical aneurysm is most efficacious for ES
in patients with HCM, mid-ventricular obstruction, and an apical aneurysm.
Abbreviations:
ES (electrical storm), HCM (hypertrophic cardiomyopathy), ICD (implantable cardioverter-defibillator), NSVT (non-sustained ventricular tachycardia), VT (ventricular tachycardia)Keywords
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Article info
Publication history
Published online: February 09, 2023
Accepted:
January 24,
2023
Received in revised form:
January 18,
2023
Received:
April 16,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
