R ARIVANANTHAM
CHENNAI, MAR 11
In a remarkable life-saving medical intervention, specialists at SIMS Hospital successfully treated a 65-year-old religious scholar who survived an extraordinary ventricular tachycardia (VT) storm requiring more than 250 emergency defibrillator shocks over five days following a complex repeat heart bypass surgery.
- Chennai doctors perform rare dual-surface heart ablation to save 65-year-old scholar after repeat bypass surgery
- Patient survived over 250 emergency defibrillator shocks during five-day battle against life-threatening arrhythmia
- Complex redo Coronary Artery Bypass Grafting followed by advanced electrophysiology intervention
- Hybrid endocardial-epicardial catheter ablation eliminates abnormal electrical circuits inside and outside the heart
- Automated Implantable Cardioverter-Defibrillator implanted to prevent sudden cardiac death in the future
Doctors eventually stabilised the patient through a highly advanced endo-epicardial catheter ablation procedure, performed from both the inner and outer surfaces of the heart—a technically demanding approach rarely required in post-surgical cardiac patients.
To protect him from future life-threatening rhythm disturbances, the medical team later implanted an Automated Implantable Cardioverter-Defibrillator (AICD), a device capable of detecting and automatically correcting dangerous heart rhythms.
A High-Risk Cardiac History
The patient had earlier undergone coronary artery bypass grafting (CABG) in 2012 at another hospital. In recent months, he developed severe chest pain and breathlessness.
Investigations including coronary angiography revealed critical blockages in multiple coronary arteries, along with failure of previous bypass grafts. Echocardiography showed that the patient’s heart pumping function had fallen drastically to around 27%, and doctors identified a scarred and calcified bulge in the lower region of the heart.
Given the severely compromised blood supply, the cardiac surgical team led by V. V. Bashi, Director and Head of the SIMS Institute of Cardiac & Aortic Disorders, performed a high-risk redo Coronary Artery Bypass Grafting to restore blood flow to the heart.
A Deadly Post-Surgery Crisis
However, within 24 hours of surgery, the patient developed repeated episodes of ventricular tachycardia, an extremely dangerous rapid heart rhythm originating from the lower chambers of the heart.
The arrhythmia did not respond to medications or specialised nerve-blocking treatments typically used for severe rhythm disturbances. To prevent cardiac arrest, doctors had to repeatedly deliver direct-current cardioversion shocks.
While ventricular arrhythmias after bypass surgery usually settle within 48 hours, the patient continued to suffer relentless attacks for more than five days, a condition known as VT storm.
During this period, the patient required nearly 50 defibrillator shocks a day, totalling over 250 shocks.
In the intensive care unit, a cardiologist and specialised nursing team remained constantly at the bedside, ready to deliver immediate life-saving shocks whenever the arrhythmia struck.
Cutting-Edge Electrophysiology Saves the Day
A specialised electrophysiology team led by Sanjai P V, Clinical Lead – Cardiac Electrophysiology and Advanced Cardiac Pacing, carried out a detailed electrical mapping of the heart to locate the abnormal circuits responsible for the rhythm storm.
Doctors initially performed ventricular tachycardia ablation from inside the heart’s main pumping chamber, targeting abnormal electrical signals originating from scarred tissue.
However, further mapping revealed that some faulty signals were originating from the outer surface of the heart.
Because previous surgeries had caused the heart to adhere closely to surrounding tissues, accessing this region was extremely challenging. The team therefore used a minimally invasive hybrid technique, making a small “keyhole” incision to deliver radiofrequency energy to the outer heart surface, eliminating the remaining arrhythmogenic circuits.
Following the successful procedure, the patient spent nearly a month in hospital, including 15 days in intensive care, before being discharged in stable condition.
A month later, doctors implanted an AICD device, which will continuously monitor his heart rhythm and automatically deliver internal shocks if a dangerous rhythm recurs, preventing sudden cardiac death.
The patient is currently recovering well and leading a stable life, doctors confirmed.
Doctors Reflect on a Rare Survival
Commenting on the case, Dr. Bashi said that redo bypass surgery itself is one of the most complex procedures in cardiac surgery.
“In my experience of nearly 45 years, this is the first time I have seen a patient requiring such a large number of defibrillator shocks continuously over five days and still recovering successfully.”
Explaining the electrophysiology intervention, Dr. Sanjai said:
“The patient developed a rare and life-threatening VT storm following surgery. The arrhythmia originated from scarred regions within the left ventricle, including a heavily calcified area. Using advanced 3D mapping, we were able to identify the abnormal circuits and eliminate them through a combined endocardial-epicardial ablation approach.”
Medical experts say the case demonstrates how advanced electrophysiology, hybrid surgical techniques and continuous intensive care monitoring can dramatically improve survival in patients facing otherwise fatal rhythm crises.
