Mapping out the dots - Could trivial myocarditis emerge as a life-threatening ventricular electrical storm? A case report

Ventricular tachycardia storm is a term used when there are three or more episodes of sustained ventricular tachycardia within 24 hours, each requiring termination by an intervention such as pharmacological cardioversion, anti-tachycardia pacing (ATP), or defibrillation. Broadly classifying, this type of arrhythmia can be due to ischemic heart disease or non-ischemic heart disease. A patient may present with a complaint of shortness of breath, palpitations, chest heaviness, syncope or even it can cause sudden cardiac death. In our case report, the patient had ventricular electrical storm activity and his initial electrocardiogram depicts the source of origin of arrhythmia from the left ventricular outflow tract and septal area. The cardiac magnetic resonance imaging (CMR) was carried out later and showed the foci of hyperenhancement in the epicardium and mid-myocardium of the left ventricle on delayed enhancement sequence suggesting localized scar and relative thinning with trabeculation. These findings more likely pointed toward previous unnoticed subclinical myocarditis that led to fibrosis and ultimately caused life-threatening electrical instability in the left ventricle.