A Case of Various Supraventricular and Ventricular Tachyarrhythmias Secondary to Polymyositis

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A 55-year-old housewife was diagnosed as polymyositis due to leg weakness, when she was 33-year-old. Polymyositis was associated with cardiomegaly and nonsustained VT. Myocarditis secondary to polymyositis was confirmed. She complained palpitation, when she was 51-year-old. Paroxysmal AF was documented. AF was eliminated by the first catheter ablation (i.e., pulmonary vein isolation). She complained exertional dyspnea due to impaired LV function caused by persistent AT last year. Secondary RF ablation was performed and AT was successfully ablated by blockline formation in the damaged right atrial anterior wall under the 3D mapping. Thereafter, frequent PVCs were recorded by Holter monitoring this year. PVCs were refractory to antiarrhythmics. Therefore, third RF ablation was conducted under the CARTO mapping. Polymorphic PVCs were originated from LV posterolateral and right ventricular inferior walls. These foci of PVCs were coincided well with the areas showing contractile abnormalities. PVCs were ablated successfully under the pace-mapping. After the third RF ablation, PVCs were remarkably decreased and LV function was gradually restored. She is well being at present under the administration of sotalol. This case is didactic in that myocarditis secondary to polymyositis demonstrates various kinds of drug-refractory tachyarrhythmias (i.e., AF, AT and VT) and RF catheter ablation is recommended in such a case.