A 46-year-old woman had been treated with implantable cardioverter defibrillator (ICD) and β-blocker since she had torsades de pointes (TdP) after her delivery when she was 40 years old (Figure A). She had sometimes felt palpitations due to frequent premature ventricular contractions (PVCs) but had been free from faintness and TdP for 6 years. However, the day after her 2nd SARS-CoV-2 vaccination (Pfizer-BioNTech), she felt sickness and frequent palpitations due to PVCs with a coupling interval similar to those previously observed (Figure A,B). Furthermore, 5 days after the vaccination, consistent with her symptom of faintness, the ICD ECG recorded a short-long-short sequence and subsequent non-sustained ventricular tachycardia (NSVT) (Figure C), the same polymorphic ventricular tachycardia, TdP, as previously observed. After day 8, when the last NSVT occurred in the morning, she felt much better, the number of PVCs decreased, and NSVT was never repeated.
Vaccination is only the essential prevention strategy to decrease the pandemic of COVID-19 virus infection, although there can be several adverse effects in the early- and late-phase periods after vaccination. In Japan, there is no evidence for how to recommend the vaccination for patients with fatal arrhythmias such as long-QT syndrome or Brugada syndrome. In the present, the frequent PVCs were sometimes seen before the vaccination and several factors such as mental stress, fever, and immunological changes can be considered as the cause of the NSVT. Furthermore, NSVT developed almost 1 week after vaccination, thus the SARS-CoV-2 vaccination might not be directly associated with the development of NSVT such as TdP. However, we need to take more care of patients with similar potential risk of fatal arrhythmias after vaccination for SARS-CoV-2.
IRB Information
National Cerebral and Cardiovascular Center ethics committee: M29-167-5.
