Key result
Medical therapy and ILR successfully manage a sustained monomorphic VT case with 0 three-year recurrences.
Why the study?
Sustained monomorphic ventricular tachycardia is a rare, underdiagnosed pathology with poor prognosis that causes arrhythmic sudden cardiac death, presenting diagnostic challenges when multiple potential etiologies coexist.
Case Report (n=1)
This case report highlights the complex diagnostic workup and successful medical management of a patient presenting with sudden sustained monomorphic ventricular tachycardia and multiple potential etiologies.
Introduction. Sustained monomorphic ventricular tachycardia (VT) ? SMVT is a rare, underdiagnosed pathology with a very poor prognosis. Along with ventricular fibrillation, SMVT is responsible for nearly all of the arrhythmic sudden cardiac deaths (SCD). The most common cause of VT is ischemic heart disease, but there are many other reasons, among which are arrhythmogenic right ventricular cardiomyopathy (ARVD) and myocardial bridging phenomenon. Treatment options include a hybrid approach consisting of antiarrhythmic drugs, catheter ablation, and implantable cardioverter defibrillators (ICD). Case report. We present a case of a 46-year-old man, a military officer, who experienced chest pain, palpitations, and nausea during regular physical activity at home. Due to the symptoms described, he was examined immediately and diagnosed with SMVT. Shortly after the diagnosis, he lost consciousness and was successfully resuscitated. A complete non-invasive and invasive cardiology examination was performed. It revealed that the patient had stable coronary disease and a muscle bridge on the left anterior descending artery. An ARVD was suspected after transthoracic echocardiography and heart magnetic resonance imaging. Genetic testing for ARVD was negative, but according to the Heart Rhythm Society expert consensus criteria, we had enough for a definitive diagnosis. The patient was hospitalized for ten days and treated with drugs without recurring VT or other disorders. We implanted an implantable loop recorder before the discharge and monitored the heart rhythm for one year. During a three-year follow-up, all of his electrocardiographic findings presented sinus rhythm without heart rhythm disorders. Conclusion. Sudden SMVT is the most common cause of SCD. It is of inestimable importance to carry out a detailed examination and determine the immediate cause of the arrhythmia and the right therapy, which, for these patients, is a life-saving form of treatment. Therapy includes medications, electrophysiology or ICD, or a combination of these treatment approaches.
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Jović et al. (2023) conducted a case report in Sustained monomorphic ventricular tachycardia (n=1). Medical therapy and implantable loop recorder was evaluated. Medical therapy and an implantable loop recorder successfully managed a 46-year-old man with sudden sustained monomorphic ventricular tachycardia, with 0 recurrences over a 3-year follow-up.
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