VENTRICULAR ELECTRICAL STORM FOLLOWING LEADLESS PACEMAKER IMPLANTATION

Document Type

Conference Proceeding

Publication Date

4-1-2025

Publication Title

J Am Coll Cardiol

Keywords

antiarrhythmic agent, adverse device effect, aged, biventricular implantable cardioverter defibrillator, bradycardia, case report, clinical article, complication, conference abstract, defibrillation, electrical storm (heart), electrocardiography, heart catheterization, heart proarrhythmia, heart ventricle fibrillation, human, hypertrophic obstructive cardiomyopathy, implant site, leadless pacemaker, left anterior descending coronary artery, male, monomorphic ventricular tachycardia, pacemaker implantation, scar tissue, sick sinus syndrome, subcutaneous tissue, therapy, thorax pain, very elderly

Abstract

Background: Leadless pacemakers (LP) are alternative to transvenous pacemakers for bradyarrhythmia, offering favorable safety profile. We report a rare yet significant complication of ventricular electrical storm after LP insertion. Case A 65-year-old male with hypertrophic obstructive cardiomyopathy and sick sinus syndrome presented after his subcutaneous implanted cardioverter-defibrillator (ICD) was discharged which was thought to be from pause-dependent ventricular fibrillation (VF) and was treated by LP. Two days later, the patient had recurrent refractory monomorphic ventricular tachycardia (MVT) requiring defibrillation. Subsequent left heart catheterization led to stenting of left anterior descending artery. His discharge was uneventful but returned a week later with chest pain and multiple ICD shocks along with EKG showing persistent MVT despite antiarrhythmics. An EP study revealed scar tissue in LV, which was ablated but the VT storm persisted post-ablation. A repeat EP study was performed, leading to the removal of the leadless pacemaker and implantation of a biventricular ICD, which resolved the VT storm. Decision-making Persistent MVT after LP insertion raised concern for ischemia, prompting cardiac catheterization and stenting. When VT storm persisted, EP study was done which identified a potential site for ablation in the LV. The patientʼs MVT persisted even after ablation and medical management. A repeat EP study identified the LP implantation site as the origin of the MVT. LP was removed leading to the resolution of arrhythmia. Conclusion Persistent MVT post LP implantation highlights temporal relationship as arrhythmias ceased after LP removal illustrating a significant complication. The proposed mechanisms of MVT post LP implantation include myocardial irritation and proarrhythmic effects of LP components. Our case aims to educate physicians for the need of further research into the safety profile of LP.

Volume

85

Issue

12

First Page

4096

Find It @ Sladen

Share

COinS