Refractory Electrical Storm in the Absence of Structural Ischemic Heart Disease

Ventricular tachycardia (VT) is characterized as a ventricular rhythm with a QRS >120 milliseconds (ms) and >100 beats-per-minute (BPM) in the absence of an aberrant conduction. It is classified as sustained when lasting >30 seconds. Risk factors associated with the development of VT include increasing age and coronary artery disease with concurrent left ventricular dysfunction, other forms of structural heart disease and acquired or congenital abnormalities in the cardiac sodium, potassium or calcium channels. Diagnosing VT is challenging based on history and physical exam alone. Combination of electrocardiogram (EKG), electrolytes and cardiac enzymes, echocardiogram, cardiac catheterization, and electrophysiology testing are required to appropriately diagnose and characterize the etiology. The case below describes an 84-year-old female with a known history of symptomatic bradycardia status post pacemaker who presented to the emergency department (ED) after a routine device check which revealed VT with associated dyspnea. The patient did not do well with medical therapy and required ablative therapy to resolve VT.