Early Left Ventricular Thrombus Following Ventricular Fibrillation/Ventricular Tachycardia Electrical Storm

• Published in: European journal of case reports in internal medicine Vol. 9; no. 6; p. 003327
• Main Authors: Alyacoub, Ramez, ElKattawy, Sherif, Jesani, Shruti, Hernandez, Carlos Perez, Fichadiya, Hardik, Noori, Muhammad Atif Masood, Elkattawy, Omar, Williams, Edward
• Format: Journal Article
• Language: English
• Published: SMC Media Srl 23.06.2022; SMC MEDIA SRL
• Subjects: electrical storm; left ventricular thrombus; ventricular fibrillation; ventricular tachycardia
• ISSN: 2284-2594; 2284-2594
• DOI: 10.12890/2022_003327

Left ventricular thrombus (LVT) formation is a serious clinical complication of low-flow states that may be seen in an ischaemic, arrhythmic heart. While LVT formation has a poor prognosis, in the setting of myocardial infarction it is usually a result of post-infarct sequelae such as left ventricle aneurysms, and inflammatory changes from damaged tissue, with the LVT taking several days to form. Arrythmias such as ventricular tachycardia (VT) or ventricular fibrillation (VF) may also lead to thrombus formation, as they contribute to stasis due to decreased cardiac output. Large anterolateral myocardial infarctions can cause electrical or arrhythmic storm, characterized by more than three episodes of VT or VF in a 24-hour period. This prolonged state of dyskinesis further increases the risk of thrombosis, creating a compounding effect. Here, we report the case of a patient who had a VF cardiac arrest with electrical storm secondary to anterolateral myocardial infarction complicated with LVT formation found on echocardiogram after the cardiac arrest, which was absent on presentation. This thrombus formation occurred particularly early during the course of the patient’s arrest, possibly due to the compounding factors increasing the risk of thrombosis. Herein, we discuss in detail the risk factors for LVT formation, its mechanism and management options. A review of the literature also shows that LVT formation in the acute phase of arrest, as seen in our patient, is rare.