Prolonged Autonomic Dysfunction After Ventricular Ablation, Cardiac Tamponade, and Emergency Open-Heart Surgery: A First-Person Case Report with Integrated Cardiology and Autonomic Analysis
Abstract
Background: Cardiac tamponade is a recognized but uncommon complication of catheter ablation for ventricular arrhythmias. Although its immediate hemodynamic consequences are well described, prolonged autonomic sequelae after tamponade and emergency cardiac surgery remain poorly represented in the cardiology literature.
Case Summary: This report presents a first-person longitudinal case of severe multisystem autonomic dysfunction after ablation of premature ventricular ectopy arising from the left ventricular outflow tract, complicated by cardiac perforation, tamponade, and emergency open-heart repair. Post-operatively, the dominant syndrome was not persistent structural cardiac failure, but a prolonged disturbance of autonomic control characterized by marked cardiovascular lability, orthostatic intolerance, profound fatigue, and gastrointestinal dysmotility. Recovery occurred gradually over four years through multidisciplinary, symptom- directed management.
Discussion: The observed trajectory is biologically consistent with combined injury to peripheral autonomic pathways, including vagal, sympathetic, and baroreceptor-related mechanisms, compounded by inflammatory activation and ischemia- reperfusion stress associated with hemodynamic collapse and cardiopulmonary bypass. Cardiovascular improvement preceded gastrointestinal recovery, suggesting differential timelines across autonomic territories.
Conclusion: This case supports recognition of a prolonged but potentially reversible autonomic syndrome after ventricular ablation complicated by tamponade and emergency sternotomy. Earlier recognition may improve patient counselling, follow-up planning, and interdisciplinary care.