Case Reports

Refractory ventricular tachycardia: a challenge in an emergency setting. A case report

Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Received: 21 April 2025
Accepted: 17 June 2025
Published: 22 July 2025
368
Views
158
Downloads

Authors

The incidence of electrical storms or Ventricular Tachycardia (VT) storms is increasing due to the growing use of Implantable Cardioverter Defibrillators (ICDs), higher rates of ischemic heart disease, non-compliance with anti-arrhythmic medications, and misuse of other drugs. Timely recognition, accurate rhythm identification, and prompt intervention are critical in saving lives. We present a case of a middle-aged male with a prior diagnosis of idiopathic VT who arrived at the Emergency Department (ED) with palpitations. During his ED stay, he experienced refractory VT, which was managed through anti-arrhythmic medications and multiple synchronized cardioversions. Further investigation led to a diagnosis of cardiac sarcoidosis, and he was successfully treated.

Downloads

Download data is not yet available.

Citations

Nikolic G. Definition of ventricular tachycardia. Am J Cardiol 1982;50:1197-8. DOI: https://doi.org/10.1016/0002-9149(82)90443-X
Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Developed by the task force for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC) Endorsed by the Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 2022;43:3997–4126. DOI: https://doi.org/10.1093/eurheartj/ehac262
John R, Stevenson W. Approach to ventricular arrhythmias. In: Fauci A, Jameson J, Kasper D, eds. Harrison’s Principles of Internal Medicine, 20th ed. McGraw-Hill Education; 2018; Vol 1: p 1750–5.
Koplan BA, Stevenson WG. Ventricular tachycardia and sudden cardiac death. Mayo Clin Proc 2009;84:289-97. DOI: https://doi.org/10.4065/84.3.289
Shields SH, Holland RM, Small B. Pharmacology of antiarrhythmics and antihypertensives. In: Tintinalli JE, ed. Tintinalli’s Emergency Medicine, 9th ed. Published with McGraw-Hill Education. 2020; p 123–33.
Anderson RD, Kumar S, Parameswaran R, et al. Differentiating right- and left-sided outflow tract ventricular arrhythmias: classical ECG signatures and prediction algorithms. Circ Arrhythm Electrophysiol 2019;12:e007392. DOI: https://doi.org/10.1161/CIRCEP.119.007392
Jadonath RL, Schwartman DS, Preminger MW, et al. Utility of the 12-lead electrocardiogram in localizing the origin of right ventricular outflow tract tachycardia. Am Heart J 1995;130:1107-13. DOI: https://doi.org/10.1016/0002-8703(95)90215-5
Lerman BB. Mechanism of outflow tract tachycardia. Heart Rhythm 2007;4:973–6. DOI: https://doi.org/10.1016/j.hrthm.2007.03.007
Lerman BB, Belardinelli L, West GA, et al. Adenosine-sensitive ventricular tachycardia: Evidence suggesting cyclic AMP-mediated triggered activity. Circulation 1986;74:270–80. DOI: https://doi.org/10.1161/01.CIR.74.2.270
Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2018;72:e91–e220.
Tondo C, Carbucicchio C, Dello Russo A, et al. Idiopathic ventricular tachycardia: transcatheter ablation or antiarrhythmic drugs? J Atr Fibrillation 2015;7:1164.
Parker RB, McCollam PL. Adenosine in the episodic treatment of paroxysmal supraventricular tachycardia. Clin Pharm 1990;9:261-71.
Florek JB, Lucas A, Girzadas D. Amiodarone. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482154/
Goyal A, Sciammarella JC, Chhabra L, et al. Synchronized Electrical Cardioversion. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482173/
Birnie DH, Nery PB, Ha AC, Beanlands RS. Cardiac sarcoidosis. J Am Coll Cardiol 2016;68:411-21. DOI: https://doi.org/10.1016/j.jacc.2016.03.605
Chen ES, Moller DR. Etiologies of Sarcoidosis. Clin Rev Allergy Immunol 2015;49:6-18. DOI: https://doi.org/10.1007/s12016-015-8481-z
Hartge F, Skeete J, Pinedo A, et al. Multi-faceted approach to ventricular tachycardia: a review of management strategies. Pharmacoepidemiology 2024;3:265-84. DOI: https://doi.org/10.3390/pharma3030018

How to Cite



Refractory ventricular tachycardia: a challenge in an emergency setting. A case report. (2025). Emergency Care Journal, 21(4). https://doi.org/10.4081/ecj.2025.13916