Key result
Urgent coronary sinus lead revision resolved a mechanically induced electrical storm in a patient with a new CRT-D device, with no recurrent ventricular tachycardia over 10 years of follow-up.
Why the study?
Multiple recent studies suggest several mechanisms for proarrhythmia associated with cardiac resynchronization therapy devices.
Case Report (n=1)
No
This case highlights that mechanical irritation from a coronary sinus lead can cause intractable electrical storm following CRT-D implantation, which may require urgent lead revision rather than just device reprogramming.
Raises possibility of mechanical lead irritation in post-CRT electrical storm; hypothesis-generating observation requiring confirmation in larger cohorts.
BACKGROUND: Cardiac resynchronization therapy (CRT) has been shown to improve both the functional status and mortality of heart failure patients with left bundle branch block. Multiple recent studies suggest several mechanisms for proarrhythmia associated with CRT device. CASE SUMMARY: A 51-year-old male with symptomatic non-ischemic cardiomyopathy and no previous history of ventricular arrhythmias underwent placement of a biventricular cardioverter-defibrillator. The patient developed sustained monomorphic ventricular tachycardia (VT) soon after implantation. The VT recurred despite reprogramming to right ventricular only pacing. The electrical storm resolved only after a subsequent discharge from the defibrillator caused inadvertent dislodgement of the coronary sinus lead. No recurrent VT occurred throughout 10-years follow up after urgent coronary sinus lead revision. DISCUSSION: We describe the first reported case of mechanically induced electrical storm due to the physical presence of the CS lead in a patient with a new CRT-D device. It is important to recognize mechanical proarrhythmia as a potential mechanism of electrical storm, as it may be intractable to device reprogramming. Urgent coronary sinus lead revision should be considered. Further studies on this mechanism of proarrhythmia are needed.
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Feng et al. (2023) conducted a case report in Non-ischemic cardiomyopathy (n=1). Coronary sinus lead revision was evaluated on Recurrence of ventricular tachycardia. Urgent coronary sinus lead revision resolved a mechanically induced electrical storm in a patient with a new CRT-D device, with no recurrent ventricular tachycardia over 10 years of follow-up.
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