Catheter Ablation for Ventricular Premature Contraction Triggering Electrical Storm

Electrical storm, defined as =3 episodes of Ventricular Tachycardia (VT) or Ventricular Fibrillation (VF) occurring within 24 hours, is a life-threatening medical emergency. A 73-year-old gentleman, with a history of diabetes mellitus and hypertension, presented with congestive heart failure. An Electrocardiography (ECG) showed borderline ST-T changes over anterior wall and high sequential blood troponin-I levels were noted. Accordingly, non-ST elevation myocardial infarction, Killip III, was diagnosed. Percutaneous coronary intervention was performed with one drug-eluting stent placement into middle left anterior descending artery and two drug-eluting stents placement into proximal-tomiddle right coronary artery under Intra-Aortic Balloon Pumping (IABP) support. Three days later, he experienced electrical storm in spite of amiodarone and lidocaine administration and deep sedation. Extracorporeal Membrane Oxygenation (ECMO) setup was inserted for electrical storm. Bedside lead II ECG showed on ventricular premature beat triggering VF. Therefore, he received radiofrequency catheter ablation under ECMO, IABP and ventilator support. 3D mapping by Ensite Navix mapping system demonstrated border zone along the left posterior fasicle and large scar area distributed across the inferior and anteroseptal wall of left ventricle. Purkinje-like potentials were registered at the border zone. Radiofrequency energy was appiled along the border zone from the inferoposteroseptal to anteroseptal wall of left ventricle till elimination of Purkinje potentials and substrate modification of the border zone. No more VT/VF could be induced by programmed ventricular stimulation after ablation. Subsequently, an Implantable Cardioverter Defibrillator (ICD) was implanted and ICD interrogation did not show any episode of VF/VF during the subsequent 3-month follow-up period.