spontaneous episode of polymorphic ventricular tachycardia in a patient with intermittent brugada...
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EP IMAGES: FROM CELL TO BEDSIDESection Editor: David S. Rosenbaum, M.D.
Spontaneous Episode of Polymorphic Ventricular Tachycardiain a Patient with Intermittent Brugada Syndrome
J. CHRISTOPH GELLER, M.D., SVEN REEK, M.D., ANDREAS GOETTE, M.D.,and HELMUT U. KLEIN, M.D.
From the Arrhythmia Service, Division of Cardiology, University Hospitals, Magdeburg, Germany
A 54-year-old patient presented with aborted suddencardiac death and documented ventricular � brillation. Onadmission, there were no signi� cant abnormalities on 12-lead ECG. Extensive diagnostic work-up (echocardiogra-phy, right and left heart catheterization, and coronary an-giography) did not show structural heart disease. DuringECG telemetry monitoring (lead I represents a bipolar pre-cordial lead), a spontaneous episode of polymorphic ven-tricular tachycardia (VT) occurred. Before the episode
started, gradual changes in the terminal QRS complex andST segment were seen. Directly before the short runs ofnonsustained VT, right bundle branch block-like changesand downsloping ST segment elevation were seen. The QTinterval remained normal. After a longer episode of poly-morphic VT terminated spontaneously, the signi� cantchanges in ST segment reverted. This sequence of eventssuggests a causal relationship between the changes in car-diac repolarization and development of the arrhythmia.
Pharmacologic challenge with ajmaline 25 mg revealedright bundle branch block-like changes and downsloping STsegment changes in leads V1 to V3. During electrophysi-ologic testing, polymorphic VT was inducible with twoextrastimuli, and an automatic de� brillator was implanted.After ICD placement, the patient experienced three appro-priate shocks for rapid VT. All episodes were terminatedsuccessfully by the device.
J Cardiovasc Electrophysiol, Vol. 12, p. 1094, September 2001.
Address for correspondence: J. Christoph Geller, M.D., Arrhythmia Ser-vice, Division of Cardiology, University Hospitals, Leipziger Strabe 44,39120 Magdeburg, Germany. Fax: 49-391-671-3202; E-mail: [email protected]
1094 Reprinted with permission fromJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Volume 12, No. 9, September 2001
Copyright ©2001 by Futura Publishing Company, Inc., Armonk, NY 10504-0418