Implantable Cardioverter-Defibrillator(ICD) Therapy in a Patient with Recurrent Ventricular Fibrillation after Myocardial Infarction

ABSTRACT

If ventricular fibrillation develops after acute myocardial infarction, it should be treated immediately with the external electrical cardioversion and antiarrhythmic agents, followed by the rapid correction of the reversible and underlying cause. Nevertheless, if ventricular fibrillation recurs, ICD(implantable cardioverter-defibrillator) therapy is necessary. ICD is an important nonpharmacological option in the treatment of malignant ventricular arrhythmias. A 53 year old man was admitted into our hospital with a severe chest pain of 9 days. On cardiac catheterization, a significant stenosis at the mid-left anterior descending coronary artery and a huge ventricular aneurysm were found. Then PTCA(percutaneous transluminal coronary angioplasty) with a stent was taken. Three days later, two episodes of ventricular fibrillation developed and it was treated with electrical cardioversion and antiarrhythmic agents. On the second look of cardiac catheterization, a subacute closure of the stented site was detected and then the culprit leision was recanalized with repeated PTCA and another stent was implanted. But ventricular fibrillation recurred although the stented lesion still patent on the third look of cardiac catheterization. After all, we implanted ICD on him. 46 Episodes of ventricular fibrillations developed at the same day and the next day of ICD implantation. All of the episodes of ventricular fibrillation were successfully converted to sinus rhythm with shocks from ICD. Since then, the frequency of ventricular fibrillation decreased with IABP(intraaortic balloon pump) therapy. We report the first case of malignant ventricular fibrillation after myocardial infarction which was uncontrolled with conventional therapy, but effectively treated with ICD.