# Coronary Fistula–Induced Ventricular Tachycardia From Thrombotic Cyst Compression: A Case Report

## TL;DR

A rare case of ventricular tachycardia caused by a thrombotic cyst from a coronary artery fistula is reported, highlighting its life-threatening complications.

## Contribution

This case report highlights the rare but severe complication of thrombotic cysts from coronary artery fistulas leading to ventricular tachycardia.

## Key findings

- Thrombotic cysts from coronary artery fistulas can cause irreversible myocardial fibrosis and ventricular tachycardia.
- ECG findings like fragmented QRS and ST depression indicate irreversible myocardial damage in such cases.
- Surgical resection may not prevent recurrence of VT, leading to cardiogenic shock and death.

## Abstract

Coronary artery fistula (CAF) complicated by thrombotic cyst formation is a rare cause of ventricular tachycardia (VT), involving ischemia and mechanical compression.

A 55‐year‐old woman presented with palpitations, chest pain, monomorphic VT (negative V1–V6), and elevated troponin I. Imaging revealed a large right ventricular cyst. Surgical resection confirmed a thrombotic cyst communicating with a CAF. Postoperative VT recurred, leading to cardiogenic shock and death.

CAF‐related thrombotic cysts can cause irreversible myocardial fibrosis, creating a persistent VT substrate unresponsive to anatomical intervention alone. ECG markers (fragmented QRS, ST depression) reflect irreversible damage.

At presentation. Initial electrocardiogram: the presence of exclusively negative QRS complexes across all precordial leads (V1 through V6) supported the diagnosis of ventricular tachycardia.