Posterior cardiac compression from a large hiatal hernia—A novel cause of ventricular tachycardia

Key Teaching Points•Large hiatal hernia can cause extensive posterior cardiac compression including frequent compression of the basal inferior left ventricular wall, with such changes resolving post hernia repair.•The implications of hiatal hernia–induced cardiac distortion on arrhythmia pathogenesis are poorly recognized.•Atrial arrhythmias have been described, which are likely attributable to left atrial compression.•Hiatal hernia–induced posterior cardiac compression and associated mitral annular region distortion seems to have caused a propensity to frequent symptomatic ventricular tachycardia (VT) in our case, with postoperative resolution of compression correlating with VT resolution.•Early recognition of this association with arrhythmogenesis is imperative, as hiatal hernia may be a treatable cause of such arrhythmias. •Large hiatal hernia can cause extensive posterior cardiac compression including frequent compression of the basal inferior left ventricular wall, with such changes resolving post hernia repair.•The implications of hiatal hernia–induced cardiac distortion on arrhythmia pathogenesis are poorly recognized.•Atrial arrhythmias have been described, which are likely attributable to left atrial compression.•Hiatal hernia–induced posterior cardiac compression and associated mitral annular region distortion seems to have caused a propensity to frequent symptomatic ventricular tachycardia (VT) in our case, with postoperative resolution of compression correlating with VT resolution.•Early recognition of this association with arrhythmogenesis is imperative, as hiatal hernia may be a treatable cause of such arrhythmias.