Abstract
A 62 year old man was admitted for evaluation of recurrent episodes of syncope. A surface ECG showed frequent repetitive premature ventricular complexes of right ventricular outflow tract origin. Ventricular fibrillation was inducible by programmed electrical stimulation but otherwise cardiac evaluation was unremarkable. A diagnosis of idiopathic ventricular fibrillation was made and an implantable cardioverter-defibrillator (ICD) was installed. However, spontaneous ventricular fibrillation recurred, requiring repeated ICD discharges. The ventricular fibrillation was reproducibly triggered by a single premature ventricular complex with a specific QRS morphology. Radiofrequency catheter ablation was carried out to eradicate this complex. No ventricular fibrillation has developed after this procedure, and the patient does not require drug treatment. Keywords: ventricular fibrillation; radiofrequency ablation
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Figure 1 .
Reproducible pattern of spontaneous initiation of ventricular fibrillation (VF). (A) Spontaneous VF documented on the monitored ECG four days after implantable cardioverter-defibrillator (ICD) installation. The coupling interval of the first premature ventricular complex triggering VF was 320 ms, which was identical to that of the preceding bigeminal isolated premature ventricular complex. (B) Spontaneous VF recurrence was recorded by the monitored ECG six days after ICD implantation. The manner of induction was almost the same as in (A), with a bigeminal premature ventricular complex (coupling interval 330 ms) triggering VF.
Figure 2 .
Twelve lead ECG during catheter ablation for right ventricular outflow tract premature ventricular complexes (PVC). The coupling interval of the PVC couplet became longer after the onset of radiofrequency application (†720 ms) than before (*260 ms). Five seconds after radiofrequency energy began to be delivered, PVCs disappeared completely.
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
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