Ultrashort case report on VF storm in immediate Post CABG Period—‘Angry Purkinje Syndrome’

Joseph Theodore

Interventional Cardiologist and Electrophysiologist, Kauvery Hospital, Heart city, Trichy

Background

The Angry Purkinje Syndrome is a rare but important cause of ventricular tachycardia storm after CABG surgery

Mechanism: short-coupled ventricular ectopy in the absence of acute myocardial ischaemia and transient peri-infarct Purkinje fibre irritability.

Ablation, Quinidine and Intra Cardiac Defibrillator (ICD) are the cornerstones in the treatment of this life threatening arrhythmia

Case Presentation

A 50 Years-old male patient with Anterior Wall Myocardial Infarction (AWMI) and moderate LV dysfunction underwent CABG.

Postoperatively he developed repeated Ventricular Fibrillation (VF) storm precipitated by short coupled Ventricular Premature Contractions (VPC). He received 25 DC shocks in a span of 12 hrs; none of the drugs and overdrive pacing weret effective. Electrolytes and check angiogram were normal.

Management

  • In utter desperation he was taken for ablation and short coupled VPC along with early purkinje potentials were targeted in a dense anterior wall scar.
  • VF free period of few hrs was achieved but with few runs of NSVT.
  • Quinine and Phenytoin were loaded and he remained VT free thereafter.
  • He received a ICD after 3 days and walked back home

 

Dr Joseph T

Dr. T. Joseph
Consultant Interventional Cardiologist

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