Relentless VT refractory to AICD shock in a patient with mildly atheromatous coronary arteries. Send to catheter ablation center

A 74-year-old man, dyslipidemic, underwent cardiac surgery for DIA about 30 years ago, who had been carrying biventricular AICD for about 5 years when he was performing negative coronary angiography for significant stenosis. Replacement of the AICD 2 years ago due to premature battery depletion due to high threshold of the left catheter. He is hospitalized for incessant VT refractory to AICD electrical therapy and pharmacologically regressed upon entry into the ward with IV cordarone bolus and IV MG SO4 infusion. Several times subjected to a negative covid 19 swab. Coronary angiography examination performed with coronary arteries angiographically free from significant stenosis and only slightly atheromatous. Stabilized from an electrical point of view with metoprolol therapy 100 mg x 2/day. Subjected in the following days to replacement of AICD for end of life. The patient is sent to a catheter ablation center to verify the functioning of the device with induction tests, left and right pace-mapping and ablation of the shock-refractory ventricular hyperkinetic arrhythmia. Subjected to ablation of right VT in two foci: inferior septal basal and peritricuspid. Inserted in arrhythmological follow up and device control in therapy with beta-blockers and cordarone. The case in question opens the discussion on the advantage represented by integrated procedures on this type of patients. The shock- refractory arrhythmic form was effectively treated by catheter ablation at a level III electrophysiology center with which it is in close collaboration. The patient therefore receives clinically triple protection: AICD, Ablation and drug therapy, against the possible onset of severe arrhythmic forms, in a prognostic key. The patient returns to the hospital after a few days for atrial flutter with an average ventricular rate of 140 b/m ', movement of the Trop I with high sensitivity and primary modifications (deepening of T waves on BBS) post tachycardia, following omission of dose of metoprolol 100 mg. Subjected to coronary angiography and FFr which resulted in 95, therefore the mild non-stenosing atheroma of the previous coronary angiography is confirmed. He is discharged in conditions of clinical stability. (Figure Presented).