Challenges in the diagnosis and management of idiopathic ventricular fibrillation Jonathan Lipton, MD, PhD, George J. Klein, MD, Raymond W. Sy, MBBS,

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Presentation transcript:

Challenges in the diagnosis and management of idiopathic ventricular fibrillation Jonathan Lipton, MD, PhD, George J. Klein, MD, Raymond W. Sy, MBBS, PhD HeartRhythm Case Reports Volume 1, Issue 5, Pages 269-274 (September 2015) DOI: 10.1016/j.hrcr.2015.02.008 Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 1 Baseline 12-lead electrocardiogram. HeartRhythm Case Reports 2015 1, 269-274DOI: (10.1016/j.hrcr.2015.02.008) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 2 Telemetry recordings demonstrating nonsustained episodes of polymorphic ventricular tachycardia. Both episodes are initiated by a short coupled (280–300 ms) premature ventricular beat. HeartRhythm Case Reports 2015 1, 269-274DOI: (10.1016/j.hrcr.2015.02.008) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 3 A: Printout of the implantable cardiac defibrillator (ICD) during syncope. Ventricular fibrillation is detected and successfully treated with a shock. B: Incidence of VF/VT episodes detected and treated by the ICD under medical treatment and after ablation. AEGM = atrial electrocardiogram; MAR = marker channel; NSVT = nonsustained ventricular tachycardia; VEGM = right ventricular tip-to-ring electrocardiogram; VF = ventricular fibrillation; VT = ventricular tachycardia. HeartRhythm Case Reports 2015 1, 269-274DOI: (10.1016/j.hrcr.2015.02.008) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 4 Polymorphic ventricular tachycardia (PMVT) preceded by a short coupled premature ventricular beat with a narrow QRS complex, qR pattern in lead V1, and left superior axis. Morphology is nearly identical in the initiating beat recorded on Holter monitoring (A) and during electrophysiologic study (EPS) (B). HeartRhythm Case Reports 2015 1, 269-274DOI: (10.1016/j.hrcr.2015.02.008) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 5 Left anterior oblique (LAO) projection of catheter positions during mapping of Purkinje potentials. The mapping catheter and decapolar catheter are positioned using a retroaortic approach on the left septum. The dual-chamber implanted defibrillator and leads are visible. CS = coronary sinus; HBE = His-bundle electrode; LV = left ventricle; RA = right atrium; RV = right ventricle. HeartRhythm Case Reports 2015 1, 269-274DOI: (10.1016/j.hrcr.2015.02.008) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 6 Intracardiac electrocardiograms. A: Arrow highlights the proximal-to-distal activation of presystolic Purkinje potentials along the septum in sinus rhythm. B: Episode of polymorphic ventricular tachycardia. Black arrows indicate presystolic Purkinje potentials. White arrows indicate diastolic Purkinje potentials. S9,10 were located at the proximal left ventricular septum. MAP indicates signals from the ablation catheter, which was positioned parallel to the decapolar catheter. HeartRhythm Case Reports 2015 1, 269-274DOI: (10.1016/j.hrcr.2015.02.008) Copyright © 2015 Heart Rhythm Society Terms and Conditions