The role of multimodal cardiac imaging in managing electrical storms in severe heart calcifications: a case report.

BACKGROUND: Intramyocardial calcifications are rare and associated with conditions such as myocardial infarction, rheumatic heart disease, and calcium metabolism disorders. These calcifications carry significant prognostic value, often leading to severe complications like ventricular arrhythmias, increased morbidity, and mortality. They can pose challenges for treatment, especially when ablation is ineffective due to the calcifications acting as physical barriers.

CASE SUMMARY: A 43-year-old male with a history of extensive myocardial calcifications and recurrent ventricular tachycardia (VT) presented with a prolonged electrical storm, despite having an implantable cardioverter-defibrillator (ICD). Multiple ICD shocks and overdrive pacing temporarily restored sinus rhythm, but VT recurred. Initial management with amiodarone and electrical cardioversions failed to control the arrhythmias. The patient required sedation and intubation for 36 h. High-dose amiodarone and general anaesthesia eventually stabilized the arrhythmia. Post-sedation, the patient was discharged with oral amiodarone and bisoprolol, without further arrhythmia.

DISCUSSION: This case underscores the challenges in managing electrical storms in patients with extensive intramyocardial calcifications, which hinder ablation procedure and contribute to persistent arrhythmias. Effective management of life-threatening arrhythmias in these patients requires a comprehensive approach, including multimodality cardiac imaging, collaborative decision-making by a multidisciplinary team, advanced antiarrhythmic therapy, and sedation when necessary.