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.