Authors

• Zoran Bakotić — Zadar General Hospital, Zadar, Croatia — ORCID: 0000-0002-7095-0111
• Marin Bištirlić — Zadar General Hospital, Zadar, Croatia
• Ante Anić — Zadar General Hospital, Zadar, Croatia — ORCID: 0000-0002-6864-3999

Keywords

ischemic ventricular tachycardia, atrial fibrillation, electrocardioversion, intracardial ultrasound, electrophysiology

DOI

Full Text

**Introduction**: There are emergency situations in everyday cardiology practice that can been easily solved with basic electrophysiological maneuvers and with greater safety for the patient compared to conventional treatment methods. (1) **Case report**: We report a case of a 76-year-old patient with a history of myocardial infarction 10 years ago, now presenting to Emergency Department with mild chest pain during last 3 hours, caused by sustained ventricular tachycardia with frequency of 140 bpm. Beside mild chest pain the arrhythmia was well tolerated, without signs of hemodynamic instability. From the available medical history there was information about persistent atrial fibrillation for the past 5 years and it was recommended anticoagulant therapy which he did not take (CHA2DS2-Vasc = 4). Last echocardiographic report described hypokinetic basal segment of posterior wall of left ventricle with a relatively preserved LVEF of 45%. Pharmacological conversion with amiodarone was attempted but with no success, and even after 10 hours of ongoing arrhythmia a patient showed no signs of hemodynamic instability. A synchronized electrocardioversion under general anesthesia was planned but with high probability of atrial conversion as well and thus the risk for thromboembolic incident in the case of the presence of thrombus in the left atrial appendage (LAA). Therefore, we decided to try another approach and the patient was transferred to the EP lab. After placing the intracardial ultrasound probe in the right atrium, an LAA with thrombotic masses was showed. A standard diagnostic electrophysiological catheter was placed in right ventricle (RVA) and ventricular tachycardia was terminated with simple overdrive pacing and the patient remained in atrial fibrillation with normal ventricle frequency and without problems. **Conclusion:** There is remaining dilemma regarding further treatment of this patient like permanent anticoagulant therapy, implantation of an implantable cardioverter-defibrillator or just radiofrequency ablation without implantation of device, only medication therapy?!

Literature

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