Patient with multiple ICD interventions (RCD code: V‑2A.O)

Abstract

The authors report a case of a 58-year-old man with coronary artery disease and left ventricular aneurysm following inferior wall infarction, who was implanted with a single chamber cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death. The patient presented with complaints including multiple ICD shocks due to recurrent ventricular tachycardia (VT) resistant to the implemented treatment, decreased quality of life and high level of anxiety associated with multiple hospitalizations. Pharmacological treatment was unsuccessful and led to drug-induced bradycardia. Due to developed pacemaker syndrome the patient underwent ICD upgrade to a dual-chamber device followed by radiofrequency ablation. Despite a number of interventions, VT did not completely disappear. A slight decrease in the number of ICD shocks was observed. After adjustment of the pacing lower rate up to 75 bpm, ventricular arrhythmias were reduced and eventually retreated. In the six months follow-up period no VT was recorded. The authors discuss the current recommendations for VT treatment with the indications for re-ablation or aneurysmectomy. JRCD 2016; 3 (1): 20–23