# "Cutting Through the Storm": Surgical Rescue of an Electrical Storm in Post-Myocarditic Aneurysm

## TL;DR

A man with severe heart rhythm issues was successfully treated with surgery and cryoablation after multiple other treatments failed.

## Contribution

Demonstrates successful surgical rescue of refractory ventricular tachycardia using ventricular reconstruction and cryoablation.

## Key findings

- Surgical ventricular reconstruction and cryoablation resolved refractory VT in a patient with post-myocarditic aneurysm.
- The patient recovered fully and remained free of VT for 11 months post-surgery.
- Multidisciplinary evaluation was critical in selecting surgical intervention over prior failed ablations.

## Abstract

Ventricular tachycardia (VT) refractory to medical therapy and catheter ablation remains a challenging condition, particularly when associated with localized ventricular aneurysms. Surgical ventricular reconstruction combined with intraoperative cryoablation is rarely performed but may be curative in selected cases.

We present the case of a 43-year-old man with recurrent VT originating from a localized inferobasal aneurysm secondary to prior myocarditis. Despite four endocardial and one epicardial catheter ablations performed in multiple centers, optimal medical therapy, and subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation, the patient experienced electrical storm requiring extracorporeal membrane oxygenation (ECMO) and continuous venovenous hemodiafiltration (CVVH). After multidisciplinary discussion, surgery was decided due to previous ablation failures and a well-identified arrhythmogenic substrate.

Surgical ventricular reconstruction using the Dor procedure and intraoperative cryoablation was performed following careful multidisciplinary evaluation. The aneurysmal tissue was successfully resected, and the left ventricle was reconstructed with a tailored Dacron patch. Cryoablation targeted arrhythmogenic zones around the resection margins. The patient recovered uneventfully, was weaned off ECMO and CVVH within 24 hours, and remained asymptomatic without VT recurrence during an 11-month follow-up.

This case highlights the potential role of surgical ventricular reconstruction with cryoablation in managing refractory VT due to post-myocarditic ventricular aneurysm within a multidisciplinary framework.