Abstract
A 79-year-old male with a history of hypertension, diabetes mellitus, dyslipidemia, and two-vessel coronary artery disease, previously treated with percutaneous coronary intervention of the left circumflex artery one month earlier, was admitted for stable angina. Coronary angiography and intravascular ultrasound revealed a long, diffuse, severely calcified lesion in the left anterior descending artery. Lesion preparation with high-pressure balloon dilation was unsuccessful. Therefore, intravascular lithotripsy (IVL) was performed to modify the calcified plaque, followed by successful stent implantation with optimal expansion and TIMI 3 flow. After the procedure, the patient developed chest discomfort accompanied by ventricular ectopy and episodes of non-sustained ventricular tachycardia, with QRS morphology similar to those observed during IVL energy delivery. These arrhythmias persisted for two days and were associated with dynamic elevation of cardiac biomarkers, while hemodynamic status remained stable. Symptoms and arrhythmias improved with nitrate and amiodarone therapy. This case highlights that ventricular arrhythmias may not only occur during IVL but can also develop and persist after the procedure, underscoring the importance of close post-procedural monitoring in clinical practice.
