Figure 2.

Electrical storm with dynamic early repolarization. Continuous electrocardiographic tracings from the telemetry monitor in the index patient: lead II demonstrates a distinct inferior J-wave with pause-dependent augmentation (red circles) and a monomorphic short-coupled premature ventricular complex triggering polymorphic ventricular tachycardia that rapidly degenerates into ventricular fibrillation. A further increase of the J-wave amplitude (red circles) precedes recurrent ventricular fibrillation. Following each defibrillation there is instantaneous ventricular fibrillation recurrence after four, respectively, two normal beats triggered by the very first monomorphic premature ventricular complex, resulting in three ventricular fibrillation episodes within 30 s. After this last defibrillation, the patient remained in ongoing VF for >1 h due to intractable ventricular fibrillation while being protected by venoarterial extracorporeal membrane oxygenation (VA-ECMO).