A fatal ventricular fibrillation in a secondary ventricular tachycardia patient: A tale of re-eruption of ventricular tachycardia postquiescence

Abstract Ventricular tachycardia (VT) occurring late after acute myocardial infarction (AMI), typically beyond 48 h, is a significant predictor of adverse outcomes. It usually reflects underlying structural myocardial damage and electrical instability. We present a case of 60-year-old diabetic male who presented late after acute anterior wall STEMI (beyond hours) and underwent successful primary percutaneous coronary intervention (PCI) to the LAD and salvage PCI to LCx artery as detailed. He had reduced left ventricular ejection fraction (30%–35%). After 72 h of admission, he developed sudden sustained monomorphic VT with hemodynamic instability, requiring synchronized cardioversion. He was stabilized on IV amiodarone, beta-blocker, and other medical therapy and was advised for ICD, but he refused due to financial constraints. The patient was monitored for next 72 h on amiodarone loaded as per the protocol, and as he had no ventricular premature complexes (VPCs) or non sustained ventricular tachycardia (NSVT), he was put on oral antiarrhythmic drugs and shifted to the ward with Holter. He was coded blue 3 hours later in ward and succumb to it. Holter recorded Non Sustained Ventricular Tachycardia runs followed by Ventricular Fibrillation terminally preceded by R wave on T wave. This case emphasizes the importance of lack of effect of antiarrhythmics and more aggressive management include ICD or VT ablation.