Comprehensive Approaches to Managing Ventricular Tachycardia

Comprehensive Approaches to Managing Ventricular Tachycardia: Two Successful Case Studies

Ventricular tachycardia (VT) is an abnormal heart rhythm originating from the lower chambers of the heart (ventricles). In the general population, the incidence of VT is estimated to be around 0.1 to 0.4 per 1,000 people per year. However, among patients with heart disease or those who have undergone certain cardiac procedures, the prevalence can be much higher. For example, in patients with heart failure or previous myocardial infarction, the prevalence of VT can range from 5% to 15%.

VT is also more commonly observed in older individuals due to the increased likelihood of developing structural heart disease as age advances or in certain patient populations such as those with genetic channelopathies, electrolyte imbalances, or certain medications that can predispose individuals to arrhythmias. Additionally, VT can manifest as both sustained and non-sustained episodes, with the latter being more common.

These rhythms can be life-threatening and difficult to control. Patients typically have implantable defibrillators; however, patients can receive multiple shocks despite aggressive medications. Catheter ablation is considered the most effective non-pharmacological approach to reducing the recurrence of VT; however, this procedure requires specialized techniques and a team of electrophysiologists and surgeons to be successful.

Successful Treatment of Recurrent Ventricular Tachycardia in a Chagas Disease Patient Using Epicardial Ablation

Chagas disease is a rare, tropical, parasitic infection caused by the protozoan Trypanosoma cruzi, commonly transmitted through the bite of triatomine bugs. It primarily affects the cardiovascular system, leading to significant cardiac disease including heart failure and heart rhythm disorders like ventricular tachycardia.

In March 2023, a female patient who is a resident of Brazil and has a known history of Chagas disease was transferred from another hospital to Emory University Hospital Midtown after experiencing 15 defibrillator shocks and persistent VT despite being on multiple intravenous medications.

Treatment Strategy

Neal Bhatia, MD, an expert in cardiac electrophysiology, evaluated the patient’s condition. Given the recurrent nature of VT and its resistance to conventional therapies, an alternative approach was required. Dr. Bhatia opted for an epicardial ablation procedure which involves accessing the heart from the outside to target the arrhythmogenic foci.

Procedure and Outcome

Ventricular Tachycardia Figure 1 Utilizing specialized equipment and guidance tools, the epicardial ablation procedure accessed both the internal and external areas of the heart to neutralize VT-causing abnormal pathways (Figure 1), offering a potent alternative for recurrent VT cases. This approach, as demonstrated in our patient, provides a unique advantage by reaching arrhythmogenic substrates not easily accessible with conventional endocardial ablation methods, significantly enhancing the potential for complete VT eradication.

Post-Procedure Follow-up

The patient's post-procedure follow-up in May 2023 revealed promising outcomes. She had not experienced any VT episodes since the epicardial ablation, and to the delight of the medical team, she was entirely off her heart arrhythmia medications. The complete resolution of VT and the patient's improved quality of life were remarkable achievements.

Successful Management of Severe Heart Failure and VT Storm with Mechanical Pump and Ventricular Tachycardia Ablation

In May 2023, a male patient in West Georgia was suffering from severe heart failure and VT storm. Despite receiving multiple IV medications and external defibrillator shocks, the patient’s VT persisted warranting consideration for a heart transplant. The Emory Healthcare heart failure team consulted and transferred the patient to Emory University Hospital for further evaluation and management.

Treatment Strategy

Ventricular Tachycardia Figure 2 Given the patient’s poor heart pumping function, mechanical pump support was initiated to stabilize his condition. He was being considered for transplant but continued to have ventricular tachycardia despite multiple IV medications and shocks. To address the persistent VT, Anand Shah, MD, performed a ventricular tachycardia ablation procedure utilizing mechanical pumps on both sides of the heart to extinguish the dangerous rhythm (Figure 2).

Procedure and Outcome

The ventricular tachycardia ablation procedure was conducted under controlled conditions with careful mapping of the arrhythmogenic foci. The mechanical pumps provided circulatory support during the ablation, enhancing the safety and efficacy of the intervention. Dr. Shah successfully eliminated the aberrant VT circuits, restoring the heart’s normal rhythm.

Post-Procedure Follow Up

Following the ablation procedure, the patient’s condition improved significantly, enabling him to undergo a successful heart transplant. Subsequent follow-up visits at Emory Healthcare revealed no cardiac issues, demonstrating the effectiveness of the combined mechanical pump and VT ablation approach.

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