No abstract

Management of idiopathic ventricular fibrillation (IVF) is challenging because arrhythmic substrate may be missed; therefore, careful follow-up and reassessment are necessary. Three-dimensional mapping would be useful for reassessment of IVF because it revealed an arrhythmic substrate in a patient, 12 years after his initial diagnosis of IVF.

A 45-year-old man who was diagnosed with idiopathic ventricular fibrillation (IVF) 12 years ago experienced multiple implantable cardioverter defibrillator shocks due to ventricular tachycardia (VT). The recorded electrocardiogram showed VT originating from the right ventricular outflow tract (RVOT). He underwent catheter ablation for VT, and 3-dimensional (3D) mapping revealed a low voltage area in the RVOT. VT was successfully ablated at this site, and his final diagnosis was scarrelated VT, not IVF. We suggest that 3D mapping is useful for the reassessment of IVF because an arrhythmic substrate might have been missed in patients who were initially diagnosed with IVF.

Management of idiopathic ventricular fibrillation (IVF) is challenging because an arrhythmic substrate may be missed at initial diagnosis; therefore, careful follow-up and reassessment are necessary. Three-dimensional mapping would be useful for reassessment of IVF because it revealed an arrhythmic substrate in a patient, 12 years after his initial IVF diagnosis. .

We describe a 37-year-old man with spontaneous localized atrial fibrillation (AF) with an exit block at the posterior wall of the left atrium (LA). The 12-lead ECG exhibited an atrial tachycardia-like pattern, with distinctive P waves and an isoelectric baseline between the P waves. The cycle length of the P waves ranged from 320 to 500 msec. While the fractionated and rapid deflections were recorded from the posterior wall of the LA, the rest of the atria and the coronary sinus exhibited discrete atrial potentials with irregular intervals. Radiofrequency energy applications to the surrounding tissue created complete isolation of the localized AF area, and the AF was terminated. Fibrillatory activation in the posterior wall of the LA can act as a driver as well as an initiator of atrial fibrillation. (J Arrhythmia 2007; 23: 146-151)