Inducible Ventricular Tachycardia Due to Dermatomyositis-Related Cardiomyopathy in the Era of Implantable Cardioverter-Defibrillator Therapy

A 67-year-old man with a history of dermatomyositis, under treatment with prednisolone and methotrexate for the past 10 years, complained of palpitations and episodes of dizziness. During the last 3 years, the patient has been under treatment with an angiotensin II type 1 receptor blocker and amiodarone for hypertension and ventricular ectopic beats, respectively. He never experienced chest pain either on exercise or at rest. At the present evaluation, his ECG image revealed sinus rhythm with fragmented QRS complexes in the inferior leads, a sign indicative of scar and delayed conduction in the corresponding area1 (Figure 1). The laboratory tests for troponin I, creatine phosphokinase and its cardiac isoform CK-MB, and transaminases were all within normal limits. The performed 24-hour Holter monitoring revealed 6 episodes of nonsustained ventricular tachycardia (VT) with maximum ventricular rate of 157 bpm. The following echocardiography demonstrated a slight increase in left ventricular …