Forgotten But Not Gone: Polymorphic Ventricular Tachycardia Secondary to Embolizatoin of an Abandoned Ventriculoatrial CSF Catheter
Journal of the American College of Cardiology
Background: Polymorphic ventricular tachycardia (PMVT) is characterized by undulating QRS complexes. There are many causes including electrolyte disturbances, ischemia, and medications. PVCs can also induce PMVT by causing an R wave superimposed on a T wave disrupting repolarization.Case: A 49 year-old-male with a history of hydrocephalus with a ventriculopleural shunt (VPS) presented with nausea and emesis and was found to have an ileus and aspiration pneumonia. He had recently been admitted to an outside hospital for a ventriculoatrial (VA) catheter revision to a VPS with intentional retainment of the VA catheter. Hospital course involved the development of frequent PVCs inducing an episode of PMVT that self-terminated (Figure 1A).Decision-making: The etiology of PMVT was investigated. Patient had a previous CT coronary that revealed normal coronaries and VA catheter in the correct position (Figure 1B). Cardiac MRI was considered, however review of current CT imaging obtained on admission demonstrated the retained VA catheter had migrated into the RVOT and was inducing PVCs (Figure 1C and D). Patient was emergently taken for removal of the catheter, which improved the ectopy and he had no further episodes of PMVT. Conclusion: This case highlights the importance of performing a comprehensive evaluation to identify the etiology of PVCs in order to prevent consequences such as PMVT from occurring. Furthermore, review of all imaging is necessary in order to provide comprehensive patient care.
Gudipati S, Bloomingdale R. Forgotten but not gone: polymorphic ventricular tachycardia secondary to embolization of an abandoned ventriculoatrial CSF catheter. J Am Coll Cardiol. 2023 Mar;81(8 Suppl.A):2453. doi:10.1016/S0735-1097(23)02897-8