Title of presented paper: Recurrent postinfarction ventricular tachycardia in multimorbid patient with implantable cardioverter defibrillator -- a complex case report.

Introduction and aim. Patients after myocardial infarction (MI) are prone to develop ventricular tachycardia (VT). Sustained VT might result in hemodynamic instability and sudden cardiac death (SCD). Thus, antiarrhythmic pharmacotherapy, ablation and implantable cardioverter defibrillator (ICD) implantation might be required. Description of the case. A 75-year-old multimorbid male with a recent history of (1) non-ST-segment elevation MI, treated with drug-eluting stent implantation, (2) chronic heart failure with reduced left ventricular ejection fraction (HFrEF) and (3) arrhythmia, initially misdiagnosed as atrial flatter with right bundle branch block aberration, was admitted to the Cardiology Department due to palpitations. Electrocardiography showed wide QRS complex tachycardia with ventricular rate of ca. 130/min. VT was recognized and terminated by electrical cardioversion. Recurrent episode of VT was terminated by administration of lidocaine. Implantable cardioverter defibrillator (ICD) was implanted as a secondary prevention measure. Subsequently, VT reoccurred, thus electrophysiology study (EPS) was performed. EPS revealed VT originating from the basal-septal region, as well as self-limiting VT originating from the left ventricular outflow tract. The former origin was ablated. Pharmacotherapy with amiodarone was initiated. After 10 months, patient was readmitted due to electrical storm. VT was terminated after several attempts of anti-tachycardia pacing. EPS showed VT originating from the basal-septal region, where two post-MI scars were located. Another catheter ablation was performed. No VT episodes were recorded after the procedure. Conclusion. In post-MI patients with sustained VT and symptomatic HFrEF, ICD implantation should be considered in SCD prevention. Catheter ablation might additionally reduce the number of VT episodes and ICD interventions. Pharmacotherapy with amiodarone, and eventually ablation, should be considered in patients experiencing recurrent episodes of VT or electrical storm. [ABSTRACT FROM AUTHOR]