Kurath-Koller S, Sallmon H, Scherr D, Bisping E, Burmas A, Knez I, Koestenberger M.BMC Pediatr. 2020 May 11;20(1):207. doi: 10.1186/s12887-020-02113-w.PMID: 32393291 Free PMC article.
Background: There is only limited experience with wearable cardioverter-defibrillators (WCD) in pediatric patients. We report on the successful application of a WCD in an adolescent patient with hypertrophic cardiomyopathy and myocardial bridging.
Case presentation: A 15-year-old girl presented with a history of recurrent syncope, dyspnea, and vertigo with exercise. Diagnostic work-up revealed non-obstructive hypertrophic cardiomyopathy and signs of myocardial ischemia with exercise. Given this high-risk constellation, the patient was scheduled for prophylactic implantation of an implantable cardioverter-defibrillator (ICD). One month after initial presentation and days prior to the planned ICD implantation, the patient collapsed during an episode of sustained ventricular tachycardia (VT) while running. VT was terminated by WCD shock delivery. Following this event, computerized tomography scan revealed myocardial bridging of the left anterior descending coronary artery causing a 90% stenosis in systole. After coronary surgery, life threatening arrhythmias have not recurred, but due to progressive heart failure, the patient underwent successful heart transplantation after 2 years.
Conclusions: The reported case highlights the importance and applicability of WCDs and the potentially malign nature of myocardial bridging in pediatric high-risk patients.
Fig. 1 Sudden onset polymorphic ventricular tachycardia. After 30 s the LifeVest delivered an appropriate shock, converting ventricular tachycardia into sinus rhythm
Fig. 2 Sinus tachycardia (160 bpm) with ST-segment depression consistent with myocardial ischemia, which was then followed by sudden onset polymorphic ventricular tachycardia
Fig. 3 Three dimensional reconstruction of the computerized tomography scan and angiography depicting myocardial bridging of the left anterior descending coronary artery