Idiopathic ventricular tachycardia detected after coronavirus disease 2019

We present a 23-year-old woman with depression and long COVID in whom a diagnosis of idiopathic ventricular tachycardia (VT) was made. Although the relationship between idiopathic VT and long COVID remains unknown, this is the first report of idiopathic VT detected in a patient with long COVID. A 23-year-old woman was referred for brain fog that had persisted for 4 months after she had a mild case of coronavirus disease 2019 (COVID-19). She had a medical history of depression with accompanying dizziness, headache, and palpitation for 1 year. Results of physical assessment were unremarkable. Twelve-lead electrocardiography (ECG) showed normal sinus rhythm with a normal corrected QT interval. Laboratory tests showed an elevated level of plasma brain natriuretic peptide (BNP; 44.5 pg/mL, reference range < 18.4), while complete blood count and liver, renal, and thyroid function tests were normal. The patient was referred to the Department of Cardiovascular Medicine for further investigation of cardiovascular disease. Echocardiography showed no structural heart diseases; however, a cardiopulmonary exercise test induced palpitation and ECG revealed sustained monomorphic ventricular tachycardia (VT) (Figure 1). Cardiac computed tomography, cardiac magnetic resonance imaging, and Gallium-67 scintigraphy suggested no organic abnormalities. A biopsy of the myocardium showed no histopathological changes. A diagnosis of idiopathic VT was made. Radiofrequency catheter ablation was successfully conducted, and her symptoms disappeared. VT detected in a structurally normal heart is called idiopathic VT.1 Differential diagnoses include previous myocardial infarction, cardiomyopathy, and cardiac sarcoidosis. The overall age- and sex-adjusted incidence of idiopathic VT was reported to be 15.8 per 100,000, whose average age was 59.2 ± 17.6 years.2 Idiopathic VT can often be effectively treated with medications or catheter ablation; however, it may be related to morbidity and mortality.1 Idiopathic VT may cause symptoms including palpitation and presyncope,1 but in cases with mild symptoms or cases complicated with psychological disorders, as in our case, the diagnosis can be challenging. Plasma BNP concentration has been reported to be elevated in patients with symptomatic idiopathic VT and premature ventricular contraction (mean: 42.6 pg/mL).3 This case implied that increased plasma BNP level could be a clue for detecting idiopathic VT. Patients with COVID-19 have been described as having a variety of arrhythmias, with atrial fibrillation being the most common type.4 The incidence of ventricular arrhythmias, including VT, in COVID-19 patients has ranged from 1.6 to 5.9%, in which acute myocardial injury was associated with an increased risk of ventricular arrhythmias.4 Other viruses, including Zika virus, Epstein–Barr virus, and human parvovirus B19, have arrhythmogenic effects and may be associated with VT as well.5 Although the relationship between idiopathic VT and long COVID remains unknown, this is the first report of idiopathic VT detected in a patient with long COVID. KY wrote the first draft and managed the submission process. KN contributed to the clinical management of the patient and checked the manuscript. FO organized the manuscript. None. None. The authors declare no conflicts of interest. Written informed consent was obtained from the patient to publish this case report.