Electrical storm after percutaneous coronary intervention for subacute anterior myocardial infarction with heart failure, treated with multidisciplinary therapy

Figures

• 

  Figure 1. Serial chest X-ray. (A) On admission, bilateral pulmonary congestion is observed. (B) After weaning from extracorporeal membrane oxygenation, the patient developed acute heart failure, which was subsequently managed with diuretics and standard heart failure therapy, leading to gradual improvement. (C) At discharge, pulmonary congestion had resolved, and the implanted subcutaneous implantable cardioverter defibrillator (ICD) is visible following recovery of the general condition.

• 

  Figure 2. Serial ECGs. (A) ECG on admission showed sinus rhythm at 95 beats/min with first-degree atrioventricular block, left anterior fascicular block and negative T waves in leads I, aVL and precordial leads. (B) Recurrent ventricular fibrillation and tachycardia were observed for about 90 min after returning to the intensive care unit following percutaneous coronary intervention. (C) ECG at discharge demonstrated stable sinus rhythm (80 beats/min) with persistent negative T waves in the precordial leads.

• 

  Figure 3. Coronary angiography and percutaneous coronary intervention. Left: emergency coronary angiography demonstrated severe stenosis with contrast delay at the proximal segment of the LAD (#6). Right: following plain old balloon angioplasty, intravascular ultrasound imaging was performed. Plaque was observed from the proximal LAD extending into the LMT. A crossover stent was deployed from the LMT to the LAD, achieving good stent apposition and complete resolution of the contrast delay on final angiography. CRA, cranial; LAD, left anterior descending artery; LAO, left anterior oblique; LMT, left main trunk.

• 

  Figure 4. Clinical course and pharmacological management. PSGB was initiated the day after VA-ECMO implantation and repeated at weekly intervals. No further VF or VT occurred after day 17. Following weaning from MCS, the patient underwent heart failure management, subcutaneous ICD implantation and tracheostomy before transfer for rehabilitation on day 63. IABP, intra-aortic balloon pumping; ICD, implantable cardioverter defibrillator; MCS, mechanical circulatory support; PSGB, percutaneous stellate ganglion block; VA-ECMO, veno-arterial extracorporeal membrane oxygenation; VF, ventricular fibrillation; VT, ventricular tachycardia.