Electrical storm in the inflamed heart: ventricular tachycardia due to myocarditis

Gustav Mattsson, Peter Magnusson, Gustav Mattsson, Peter Magnusson

Abstract

Electrical storm during the acute inflammatory phase caused by myocarditis may be resistant to antiarrhythmic therapy. Cardiac imaging including magnetic resonance tomography, positron emission tomography, and endomyocardial biopsy are crucial to guide potential therapeutic options. Optimal management involves a multidisciplinary approach, including expertise beyond cardiology.

Keywords: Antiarrhythmic; cardiac magnetic resonance; electrical storm; implantable cardioverter defibrillator; myocarditis; risk stratification; sudden cardiac death; ventricular tachycardia.

Figures

Figure 1
Figure 1
ECG showing VT (170 bpm) with suspected right apical ventricular origin.
Figure 2
Figure 2
Four‐chamber view, T2‐weighted image: signs of edema (arrow) in the apical septum and left ventricular wall.
Figure 3
Figure 3
Four‐chamber view, early contrast: early gadolinium enhancement (arrows) in the septum and left ventricular wall.
Figure 4
Figure 4
Four‐chamber view, late contrast: late gadolinium enhancement (arrow) in the apical part of the left ventricle.
Figure 5
Figure 5
Short‐axis view, late contrast: late gadolinium enhancement (arrow) in the left ventricular wall and in the septum. Enhancement is patchy and multifocal with tendency toward endocardial sparing.

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