Electrical storm after percutaneous coronary intervention for subacute anterior myocardial infarction with heart failure, treated with multidisciplinary therapy

Electrical storm (ES) following acute coronary syndrome is rare but often fatal. A man in his early 70s experienced syncope and dyspnoea while playing golf, approximately 2 weeks after experiencing back pain. He was diagnosed with subacute anterior myocardial infarction based on pulmonary congestion, abnormal anterior wall movement and negative T waves in the precordial leads. Percutaneous coronary intervention with drug-eluting stent implantation was performed from the left main trunk to the proximal left anterior descending artery. On days 4–5 of hospitalisation, he developed recurrent ventricular fibrillation (VF) consistent with ES. High-rate pacing, deep sedation with mechanical ventilation and intra-aortic balloon pumping were initiated. To achieve more physiological pacing in the setting of severe left ventricular dysfunction, a coronary sinus lead was placed; however, ES developed shortly after catheter placement and required veno-arterial extracorporeal membrane oxygenation. Continuous VF, unresponsive to multiple direct current shocks, was finally terminated by direct-current shock after landiolol administration. Subsequent percutaneous stellate ganglion blocks stabilised the arrhythmia, allowing successful weaning from mechanical circulatory support.