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Double Trouble: Concurrent Atrial Fibrillation and VentricularTachycardia

Doble problema: fibrilacion auricular y taquicardia ventricular simultanea

Carlos A. Espinoza,* Sanjay Mehra, and Harry DeAntonio

Department of Cardiovascular Sciences, East Carolina Heart Institute at East Carolina University, North Carolina, United States

Rev Esp Cardiol. 2016;69(8):779–780

A

aVRI

II

III

V1

V5

II

150 Hz 25.0 mm/s 10.0 mm/mV 4 by 2.5s + 3 rhythm lds MAC5K 005A 12SLTM v231

aVL

aVF

V1

V2

V3

V4

V5

V6

Figure 1.

BGM1: Atip to Aring

GM3: RVtip to RVring

-A (ms)

-V (ms)

larkers

Figure 2.

* Corresponding author:

E-mail address: espinozac@ecu.edu (C.A. Espinoza).

Available online 14 April 2016

http://dx.doi.org/10.1016/j.rec.2015.12.026

1885-5857/� 2016 Sociedad Espanola de Cardiologıa. Published by Elsevier Espana, S.L.U. All rights reserved.

Document downloaded from https://www.revespcardiol.org/, day 03/04/2022. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited.Document downloaded from https://www.revespcardiol.org/, day 03/04/2022. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited.

A 50-year-old woman with a history of chronic nonischemic systolic heart failure status after implantable cardioverter defibrillator

(ICD) placement presented to the emergency department with a history of palpitations and multiple ICD shocks. Her 12-lead

electrocardiogram demonstrated narrow complex, irregular tachycardia followed by wide complex tachycardia (Figure 1). The presence of

a fusion beat and atrioventricular dissociation suggested ventricular tachycardia (VT). A 150 mg bolus of amiodarone intravenously

restored sinus rhythm. Electrolyte and thyroid function tests were within the normal reference range. Echocardiogram showed

improvement of ejection fraction from 35% to 50%. The ICD intracardiacelectrogram showed more atrial than ventricular activity. The short

and variable cycle length of the atrial recording suggested atrial fibrillation. The right ventricular electrogram morphology changed and

then accelerated with a relative fixed cycle length suggestive of VT (Figure 2). Both arrhythmias were terminated by 25J discharge

(Figure 3). A similar pattern was seen in a total of 14 recorded episodes. Previously disabled antitachycardia pacing was turned on. She had

no prior history of atrial fibrillation. In addition to the increase of metoprolol and the start of apixaban, antiarrhythmic therapy was

initiated using sotalol. The patient’s rhythm and QTc interval was monitored for 72 hours and she was then discharged home in a stable

condition. She was doing well when she was seen in the clinic 4 weeks later.

Intracardiacelectrogram from pacemaker or ICD can be paramount in the diagnosis of arrhythmias that can have serious consequences if

they remain undiagnosed and untreated.

C

VT+SVT

VT Rx 2 CV

25.2J Termination

Figure 3.

C.A. Espinoza et al. / Rev Esp Cardiol. 2016;69(8):779–780780

Document downloaded from https://www.revespcardiol.org/, day 03/04/2022. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited.Document downloaded from https://www.revespcardiol.org/, day 03/04/2022. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited.