Ventricular arrhythmias, antiarrhythmic therapy and thyroidal illness in advanced heart failure: a case report and review of the literature

Ventricular arrhythmias are common and can modify the risk profile in patients with advanced heart failure. Guideline-directed medical therapy as well as arrhythmia control are warranted to optimize outcomes and prevent sudden cardiac death. Antiarrhythmic therapy may result in undesired toxicities which can further complicate management. We present a case of an advanced heart failure patient with recurrent ventricular tachycardia and ventricular fibrillation that was refractory to guideline-directed medical therapy and resulted in him being considered for advanced heart failure therapies. We describe the clinical course of antiarrhythmic therapy and the resultant complication of clinically significant thyroid dysfunction. We also summarize our review of the literature regarding the treatment of ventricular arrhythmias in advanced heart failure and the management of antiarrhythmic therapy-induced thyroid dysfunction.