Chennai, March 11, 2026: SIMS Hospital saved the life of a 65-year-old religious scholar who developed a life-threatening ventricular tachycardia (VT) storm following a complex redo coronary artery bypass grafting. The patient required over 250 electric shocks over five days to control the dangerous heart rhythm before doctors finally stabilised him with a complex ablation procedure performed from both inside and outside the heart. To prevent future heart rhythm disturbances, doctors later implanted an Automated Implantable Cardioverter-Defibrillator, a device that can automatically detect and terminate dangerous heart rhythms.

The patient had previously undergone coronary artery bypass grafting in 2012 at another hospital. In recent months, he developed persistent chest pain and breathlessness. Investigations including coronary angiography revealed that multiple coronary arteries were critically blocked and the earlier bypass grafts had also failed. Echocardiography showed that the patient’s heart pumping function had dropped to around 27%, and doctors also identified a scarred, calcified bulge in the lower part of the heart.

Considering the failure of the earlier bypass grafts and the severely reduced blood supply to the heart, the surgical team, headed by Dr. V. V. Bashi, Director and Head of SIMS Institute of Cardiac & Aortic Disorders, performed a high-risk redo Coronary Artery Bypass Grafting (CABG) surgery to create new pathways for blood to flow to the heart by bypassing blocked coronary arteries.

However, about 24 hours after the surgery, the patient developed recurrent episodes of ventricular tachycardia, a dangerously rapid rhythm originating from the lower chambers of the heart. The abnormal heart rhythm was extremely dangerous and did not respond to standard treatments, including medications and specialised nerve-blocking procedures used to control severe rhythm disturbances. To restore normal rhythm and prevent cardiac arrest, the patient required repeated direct-current (DC) cardioversion shocks.

Although ventricular arrhythmias occurring shortly after bypass surgery usually resolve within 48 hours as heart function stabilises, the patient continued to experience incessant VT beyond five days. This condition, known as VT storm, required about 50 defibrillator shocks per day, amounting to nearly 250 shocks overall. Continuous monitoring was maintained in the intensive care unit, where a cardiologist and nursing staff remained at the patient’s bedside to deliver immediate shocks whenever the arrhythmia occurred.

Subsequently, an electrophysiology team led by Dr. Sanjai P. V, Clinical Lead – Cardiac Electrophysiology and Advanced Cardiac Pacing, conducted advanced electro-physiological evaluation and proceeded with emergency ventricular tachycardia ablation, a procedure to identify and treat abnormal electrical circuits responsible for the rhythm crisis. Initially, doctors performed the ablation procedure from inside the main pumping chamber of the heart to eliminate the abnormal electrical signals arising from scarred areas. However, some of the faulty signals were coming from the outer surface of the heart. Reaching this area was challenging because previous heart surgeries had caused the heart to stick closely to the surrounding tissues. To overcome this, doctors used a minimally invasive hybrid approach, creating a limited “keyhole” incision to deliver radiofrequency energy on the outer surface of the heart and eliminate the remaining arrhythmogenic circuits.

Following successful ablation, the patient remained in the hospital for nearly a month, including 15 days in the intensive care unit. He remained free from further VT episodes and was discharged in stable condition. One month after the procedure, the patient returned to the outpatient department and underwent implantation of an Automated Implantable Cardioverter-Defibrillator (AICD) to protect him from future malignant arrhythmias. This small device continuously monitors the heart rhythm and automatically delivers an internal shock if a dangerous rhythm recurs, thereby preventing sudden cardiac death. Currently, the patient is doing well.

In his comments, Dr. Bashi said that redo CABG itself is a complex surgical undertaking, particularly in patients with prior bypass surgeries and severely impaired heart function. However, given the patient’s progressive graft failure and severely reduced pumping capacity, surgery was the only definitive treatment option. “In my experience of nearly 45 years, this is the first time I have seen a patient requiring such a large number of defibrillator shocks continuously over five days and still recovering successfully,” he added.

Dr. Sanjai commented that the patient developed a rare and life-threatening VT storm following surgery. The arrhythmia originated from scarred regions within the left ventricle, including a heavily calcified area. Using advanced 3D mapping, we were able to identify the abnormal circuits and eliminate them through a combined endocardial-epicardial ablation approach.