Letter to the Editor: Stereotactic Cardiac Radiation to Control Ventricular Tachycardia and Fibrillation Storm in a Patient with Apical Hypertrophic Cardiomyopathy at Burnout Stage: Case Report

We value greatly the article by Park and Choi,1 entitled “Stereotactic Cardiac Radiation to Control Ventricular Tachycardia and Fibrillation Storm in a Patient with Apical Hypertrophic Cardiomyopathy at Burnout Stage: Case Report,” which was recently published in volume 35(27): e200, July 2020. The report demonstrated a case of an elderly man with apical hypertrophic cardiomyopathy (HOCM) at burnout stage and an implantable cardioverter-defibrillator, who developed ventricular tachycardia (VT) and ventricular fibrillation (VF) storm and successfully treated with stereotactic radioablation. Firstly, we would like to congratulate the authors who have nicely described the case in detail which can be used as a reference in the management and also for reporting of other cases of apical HOCM in the future. Nevertheless, we humbly believe that more information on the patients underlying cardiac condition and other comorbidity is warranted, which was explained only briefly in the report. This is because most apical HOCM follows a benign course, but several poor prognostic factors have been identified, such as young age at diagnosis, positive family history of sudden cardiac death, and present of heart failure at New York Heart Association Class II and above.2 Therefore, it is important to know whether the patient has any of the factors that lead him to fatal complications.3 At any rate, we agree with the authors that stereotactic cardiac radioablation can be considered as rescue therapy in a case of apical HOCM with life-threatening VT and VF storm that is refractory to other treatment modalities, including antiarrhythmic drug therapy and radiofrequency catheter ablation.