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Case Conference

吳宏彬醫師中國醫藥大學附設醫院心臟科

Recurrent syncope in a 23-year-old Mongolian woman

CMUH

History

23-year-old Mongolian woman presented with recurrent syncope in recent 2 years.

Syncope preceded with short of breath and palpitation

Witnessed trismus and seizure before fainting

Mother died suddenly at her twenties

CMUH

Holter 24 hr monitor ECG: Non-sustained VT

Brain CT: negative

EEG: equivocal abnormality

CMUH

QTc : 406 ms

CMUH

Daily attacks of non-sustained VT101/03/18

101/03/19

101/03/20

101/03/21

101/03/22

CMUH

Three Different QRS morphologies of the Triggering VPC

CMUH

Treadmill exercise test

Negative for ischemiaNo VT or VF was induced during TET

CMUH

Sudden Cardiac Death in Young Coronary artery anomalies, LAD bridge, CAD Primary electrical diseases:

WPW Long QT syndrome Catecholaminergic polymorphic VT Brugada syndrome Short QT syndrome Idiopathic VF Neurologic problems

CMUH

Basic intervalsSinus CL 857 ms

QRS 87 ms

AH 99 ms

HV 43 ms

SNRT 600=1103 ms 500=1000 ms

CL-1:1 AV conduction

420 ms

CL-AVB 410 ms

AEST-CL 500 ms

ERP-AVN 370 ms

CL-1:1Ret FP No VA

CMUH

Spontaneous VPC Pace mapping

LV Inferior-apico-septal location

CMUH

Purkinje potential

CMUH

Endocardial electrograms of VPC

CMUH

No more daily VT post RFCA

101/03/24

ICD implantation was performed due to only one of three morphologic VPCs ablation

CMUH

After ICD implantation

Spontaneous idiopathic VF with near syncope was noted. Aborted ICD shock due to spontaneous termination.

Disscussion

CMUH

After ablation, 24 ± 28 months, 24 patients (89%) in 27 patients had no recurrence of ventricular fibrillation without drug.

CMUH

Characteristics of Patients

Twenty-seven consecutive patients underwent attempted ablation of primary idiopathic VF in 6 centers

CMUH

VPC morphology

Patient number

RVOT 4

RBBB 10

LBBB 13

Both 4

Thank you for your attention!

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