Is the Advanced Cardiac Life Support Algorithm Always Correct? A Case of Catecholaminergic Polymorphic Ventricular Tachycardia
DOI:
https://doi.org/10.14738/bjhmr.113.16959Keywords:
Catecholaminergic polymorphic ventricular tachycardia, ventricular arrhythmia, electrical storm, ACLSAbstract
A 19-year-old male with catecholaminergic polymorphic ventricular tachycardia (CPVT) presented with outside-of-hospital cardiac arrest in electrical storm. Ventricular arrhythmias persisted while following the Advanced Cardiac Life Support (ACLS) algorithm using epinephrine boluses. Upon deviation from the ACLS algorithm and use of beta blockers, ventricular arrhythmias ceased and patient was successfully stabilized. Treatment of CPVT electrical storm is challenging due to limited guidelines. Antiarrhythmic agents such as beta blockers and flecainide are among the primary treatment options. This case report highlights a unique example of how deviation from traditional ACLS may be necessary to best treat CPVT storm.
References
Leenhardt A, Denjoy I, Guicheney P. Catecholaminergic Polymorphic Ventricular Tachycardia. Circ Arrhythm Electrophysiol. 2012;5(5):1044-1052. doi:10.1161/CIRCEP.111.962027
Kim CW, Aronow WS, Dutta T, Frenkel D, Frishman WH. Catecholaminergic Polymorphic Ventricular Tachycardia. Cardiol Rev. 2020;28(6):325-331. doi:10.1097/CRD.0000000000000302
Bergeman AT, Wilde AAM, van der Werf C. Catecholaminergic Polymorphic Ventricular Tachycardia: A Review of Therapeutic Strategies. Card Electrophysiol Clin. 2023;15(3):293-305. doi: 10.1016/j.ccep.2023.04.002
Priori SG, Napolitano C, Memmi M, et al. Clinical and molecular characterization of patients with catecholaminergic polymorphic ventricular tachycardia. Circulation. 2002;106(1):69-74. doi: 10.1161/01.cir.0000020013. 73106.d8
Sumitomo N, Harada K, Nagashima M, et al. Catecholaminergic polymorphic ventricular tachycardia: electrocardiographic characteristics and optimal therapeutic strategies to prevent sudden death. Heart Br Card Soc. 2003;89(1):66-70. doi:10.1136/heart.89.1.66
van der Werf C, Kannankeril PJ, Sacher F, et al. Flecainide therapy reduces exercise-induced ventricular arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia. J Am Coll Cardiol. 2011;57(22):2244-2254. doi: 10.1016/j.jacc.2011.01.026
Watanabe H, van der Werf C, Roses-Noguer F, et al. Effects of flecainide on exercise-induced ventricular arrhythmias and recurrences in genotype-negative patients with catecholaminergic polymorphic ventricular tachycardia. Heart Rhythm. 2013;10(4):542-547. doi: 10.1016/j.hrthm.2012.12.035
Algorithms. cpr.heart.org. Accessed October 21, 2023. https://cpr.heart.org/en/resuscitation-science/cprand-ecc-guidelines/algorithms
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Nicole I Cillis, George M Bodziock, Taylor S Ferris, Nikhil Patel, Tejit V Pothuraju, Prashant D Bhave

This work is licensed under a Creative Commons Attribution 4.0 International License.