Catheter ablation of arrhythmic storm triggered by monomorphic ectopic beats in patients with coronary artery disease

  • Petr PeichlEmail author
  • Robert Čihák
  • Markéta Koželuhová
  • Dan Wichterle
  • Vlastimil Vančura
  • Josef Kautzner



Frequent episodes of polymorphic ventricular tachycardias/ventricular fibrillation (VT/VF) in patients with coronary artery disease can be triggered by monomorphic ventricular premature beats (VPBs) and thus, amenable to catheter ablation. The goal of this study was to review single-center experience in catheter ablation of electrical storm caused by focally triggered polymorphic VT/VF.


Catheter ablation of electrical storm due to focally triggered polymorphic VT/VF was performed in nine patients (mean age, 62 ± 7 years; two females). All patients had previous myocardial infarction (interval of 3 days to 171 months). Mean left ventricular ejection fraction was 27 ± 6%. All patients presented with repeated runs of polymorphic VT/VF triggered by monomorphic VPBs.


Based on mapping data, the ectopic beats originated from scar border zone on interventricular septum (n = 5), inferior wall (n = 3), and lateral wall (n = 1). Catheter ablation was performed to abolish the triggering ectopy and to modify the arrhythmogenic substrate by linear lesions within the infarct border zone. The ablation procedure was acutely successful in eight out of nine patients. During the follow-up of 13 ± 7 months, two patients died due to progressive heart failure. One patient had late recurrence of electrical storm due to ectopic beats of different morphology and was successfully reablated.


Electrical storm due to focally triggered polymorphic VT/VF may occur either in subacute phase of myocardial infarction or substantially later after index event. Catheter ablation of ectopic beats triggering these arrhythmias can successfully abolish electrical storm and become a life-saving procedure.


Catheter ablation Ventricular tachycardia Ventricular fibrillation Coronary artery disease 


  1. 1.
    Haissaguerre, M., Shoda, M., Jais, P., Nogami, A., Shah, D. C., Kautzner, J., et al. (2002). Mapping and ablation of idiopathic ventricular fibrillation. Circulation, 106, 962–967.CrossRefPubMedGoogle Scholar
  2. 2.
    Marrouche, N. F., Verma, A., Wazni, O., Schweikert, R., Martin, D. O., Saliba, W., et al. (2004). Mode of initiation and ablation of ventricular fibrillation storms in patients with ischemic cardiomyopathy. Journal of the American College of Cardiology, 43, 1715–1720.CrossRefPubMedGoogle Scholar
  3. 3.
    Szumowski, L., Sanders, P., Walczak, F., Hocini, M., Jais, P., Kepski, R., et al. (2004). Mapping and ablation of polymorphic ventricular tachycardia after myocardial infarction. Journal of the American College of Cardiology, 44, 1700–1706.CrossRefPubMedGoogle Scholar
  4. 4.
    Bansch, D., Oyang, F., Antz, M., Arentz, T., Weber, R., Val-Mejias, J. E., et al. (2003). Successful catheter ablation of electrical storm after myocardial infarction. Circulation, 108, 3011–3016.CrossRefPubMedGoogle Scholar
  5. 5.
    Bode, K., Hindricks, G., Piorkowski, C., Sommer, P., Janousek, J., Dagres, N., et al. (2008). Ablation of polymorphic ventricular tachycardias in patients with structural heart disease. Pacing and Clinical Electrophysiology, 31, 1585–1591.CrossRefPubMedGoogle Scholar
  6. 6.
    Mlcochova, H., Saliba, W. I., Burkhardt, D. J., Rodriguez, R. E., Cummings, J. E., Lakkireddy, D., et al. (2006). Catheter ablation of ventricular fibrillation storm in patients with infiltrative amyloidosis of the heart. Journal of Cardiovascular Electrophysiology, 17, 426–430.CrossRefPubMedGoogle Scholar
  7. 7.
    Berenfeld, O., & Jalife, J. (1998). Purkinje-muscle reentry as a mechanism of polymorphic ventricular arrhythmias in a 3-dimensional model of the ventricles. Circulation Research, 82, 1063–1077.PubMedGoogle Scholar
  8. 8.
    Friedman, P. L., Stewart, J. R., & Wit, A. L. (1973). Spontaneous and induced cardiac arrhythmias in subendocardial Purkinje fibers surviving extensive myocardial infarction in dogs. Circulation Research, 33, 612–626.PubMedGoogle Scholar
  9. 9.
    Janse, M. J., Morena, H., Cinca, J., Fiolet, J. W., Krieger, W. J., & Durrer, D. (1980). Electrophysiological, metabolic and morphological aspects of acute myocardial ischemia in the isolated in the isolated porcine heart. Characterization of the "border zone". Journal de physiologie, 76, 785–790.PubMedGoogle Scholar
  10. 10.
    Nogami, A., Kubota, S., Adachi, M., & Igawa, O. (2009). Electrophysiologic and histopathologic findings of the ablation sites for ventricular fibrillation in a patient with ischemic cardiomyopathy. Journal of Interventional Cardiac Electrophysiology, 24, 133–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Takahashi, Y., Takahashi, A., & Isobe, M. (2008). Ventricular fibrillation initiated by premature beats from the ventricular myocardium not associated with the Purkinje system after myocardial infarction. Heart Rhythm, 5, 1458–1460.CrossRefPubMedGoogle Scholar
  12. 12.
    Bogun, F., Crawford, T., Chalfoun, N., Kuhne, M., Sarrazin, J. F., Wells, D., et al. (2008). Relationship of frequent postinfarction premature ventricular complexes to the reentry circuit of scar-related ventricular tachycardia. Heart Rhythm, 5, 367–374.CrossRefPubMedGoogle Scholar
  13. 13.
    Bogun, F., Krishnan, S., Siddiqui, M., Good, E., Marine, J. E., Schuger, C., et al. (2005). Electrogram characteristics in postinfarction ventricular tachycardia: effect of infarct age. Journal of the American College of Cardiology, 46, 667–674.CrossRefPubMedGoogle Scholar
  14. 14.
    Carbucicchio, C., Santamaria, M., Trevisi, N., Maccabelli, G., Giraldi, F., Fassini, G., et al. (2008). Catheter ablation for the treatment of electrical storm in patients with implantable cardioverter-defibrillators: short- and long-term outcomes in a prospective single-center study. Circulation, 117, 462–469.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Petr Peichl
    • 1
    • 2
    Email author
  • Robert Čihák
    • 1
  • Markéta Koželuhová
    • 1
  • Dan Wichterle
    • 1
  • Vlastimil Vančura
    • 1
  • Josef Kautzner
    • 1
  1. 1.Department of CardiologyInstitute for Clinical and Experimental MedicinePrague 4Czech Republic
  2. 2.Charles University in Prague, Faculty of Medicine in PlzeňPlzeňCzech Republic

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