Malignant ventricular arrhythmias during acute infectious illness: mechanisms, mapping, and targeted therapy – illustrative cases

This manuscript presents two cases of life-threatening ventricular arrhythmias occurring during the acute phase of infectious illnesses, emphasizing the role of triggered mechanisms-both early and late-along with Purkinje cell firing and inflammation in arrhythmogenesis. The first case involves a 43-year-old male with hepatitis who developed recurrent monomorphic ventricular tachycardia, exhibiting changing morphologies. The second case describes a 43-year-old male with a febrile illness who presented with recurrent ventricular fibrillation triggered by short-coupled premature ventricular contractions. These cases highlight distinct cellular mechanisms underlying post-infectious arrhythmias and the importance of targeted therapeutic strategies. Key teaching points include the distinction between early afterdepolarization- and delayed afterdepolarization-mediated arrhythmias, the impact of inflammation on arrhythmogenesis, and the utility of advanced mapping and ablation techniques when arrhythmias persist despite initial medical management.