Evaluating Physiology of a Human Heart During Ventricular Tachycardia: New Insights of Mechanical Alterations Via Beat to Beat Strain Analysis-case Report

Background: Ventricular tachycardia can be triggered by myocardial ischaemia. These often fatal events are nearly always accompanied by a significant circulatory depression. However, the exact mechanical alterations and mechanisms of adaption during such arrhythmia episodes are still unknown.

Case Summary: We report on a 71-year-old male patient with a distinct cardiovascular risk profile, recurrent incidences of dizziness and palpitations. A Holter electrocardiogram was performed showing multiple episodes of ventricular tachycardia. He was immediately transferred to our hospital for further monitoring and diagnostics. During echocardiography, one of these episodes could be recorded with a four-dimensional (4D) probe in triplane acquisition mode and strain analysis was done. Afterwards, a heart catheter examination was performed. A one-vessel coronary heart disease was diagnosed and treated with three drug-eluting stents. The burden of non-sustained ventricular tachycardia (nsVT) significantly reduced post-procedure. During the follow-up, new episodes of nsVT occurred after 6 weeks, which were treated by electrophysiological examinations.

Discussion: Modern 4D echocardiography machines offer the possibility to visualize the entire heart simultaneously. Thus ventricular arrhythmias can be evaluated using off-line strain analysis. This technology allows new real-time insights into the human heart showing compensatory mechanisms to overcome stressful episodes, such as ventricular tachycardia.