A case report of radiofrequency ablation of fascicular ventricular tachycardia after viral myocarditis

Rationale: Viral myocarditis is more common in clinical practice with arrhythmia, but it is rare to have idiopathic ventricular tachycardia. Literature review shows that there are no reports on the treatment of idiopathic ventricular tachycardia complicated by viral myocarditis. Patient’s concerns: The patient is a 19-year-old young man who developed chest tightness and chest pain after catching a cold on April 14, 2021, which lasted for 2 days. The electrocardiogram showed sinus rhythm with ST-T change. The high-sensitivity cardiac troponin test result was 0.06 ng/mL, and the cardiac color ultrasound examination found no obvious structural and functional abnormalities. Diagnoses: viral myocarditis; fascicular ventricular tachycardia. Interventions: After 10 days of myocardial nutritional support treatment, the high-sensitivity cardiac troponin T test result was 0.004 ng/mL. Long-term follow-up was conducted after discharge, and as of December 2021, the reexamination indicators showed normal. However, in March 2023, the patient went to the hospital again due to palpitation and underwent an electrocardiogram. The electrocardiogram waveform showed wide Q wave-R wave-S wave complex ventricular tachycardia and complete right bundle branch block with left posterior fascicular block, and was diagnosed as fascicular ventricular tachycardia. Tachycardia, after cardiac electrophysiological examination and radiofrequency ablation treatment. Outcomes: The patient was no recurrence occurred during the 1 year follow-up, and the 24-hour ambulatory electrocardiogram showed sinus rhythm. Lessons: In clinical work, arrhythmia is common in patients with viral myocarditis, but cases of idiopathic branched ventricular tachycardia are rare, which may lead to a relative lack of understanding of the disease and is easily associated with supraventricular tachycardia with intraventricular differential conduction. Confusion, clinically is necessary to collect more relevant cases to analyze and explore its related mechanisms and treatments. At the same time, after treatment for children and adolescents with myocarditis, follow-up electrocardiograms can be used to avoid the occurrence of malignant arrhythmias.