410. Case Report: A Curious Case of Refractory Ventricular Tachycardia – Rutgers-Robert Wood Johnson

Refractory polymorphic ventricular tachycardia in a 61-year-old patient requires a systematic, multidisciplinary approach to rule out acute ischemia and structural heart disease. Initial management of out-of-hospital cardiac arrest involves aggressive antiarrhythmic therapy, including lidocaine and amiodarone, alongside sedation to reduce sympathetic drive during electrical storms. When standard interventions fail, mechanical circulatory support like ECMO becomes a critical consideration. Advanced cardiac imaging, specifically MRI, proves vital for identifying underlying pathologies like non-obstructive hypertrophic cardiomyopathy, even in the absence of classic markers such as late gadolinium enhancement. This case underscores that a normal baseline QT interval does not rule out congenital long QT syndrome, and that persistent polymorphic VT necessitates a thorough search for both channelopathies and structural abnormalities to guide secondary prevention strategies, such as ICD implantation.