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VT Storm with ICD Shocks — EECC MCQ

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HardCardiac DevicesVT Storm with ICD ShocksEECC

A 65-year-old man with ischaemic cardiomyopathy (LVEF 25%) and recurrent sustained monomorphic VT despite amiodarone therapy has frequent appropriate ICD shocks (12 in the past month). He is on maximum tolerated beta-blocker. What is the most appropriate next intervention?

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Correct answer: C — VT ablation (catheter ablation of the VT substrate)

Explanation lettering: E = shown as A · D = shown as B · A = shown as C · C = shown as D · B = shown as E

Per the 2022 ESC VA/SCD Guidelines, catheter ablation of VT is recommended in patients with ischaemic heart disease and recurrent VT causing ICD shocks despite antiarrhythmic therapy (Class I). VT ablation targets the scar-related re-entrant circuit. Increasing amiodarone (A) risks toxicity. Adding mexiletine (D) is a consideration but ablation is preferred. Transplant (C) does not address the immediate VT burden. Reprogramming (E) does not treat the underlying arrhythmia.

Reference: ESC (2022): Guidelines for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death