A Case of a Short‐Coupled Variant of Torsades De Pointes with Electrical Storm

Abstract

TAKEUCHI, T., et al.: A Case of a Short‐Coupled Variant of Torsades De Pointes with Electrical Storm. This case report describes a short‐coupled variant of Torsades de Pointes with a characteristic ECG pattern consisting of a prominent J wave in leads V3–V6, in which an electrical storm was evoked with autonomic receptor stimulation and a blockade test. The patient's frequent VF attacks were triggered by short‐coupled premature ventricular contractions with a right bundle branch block morphology and left‐axis deviation, and were suppressed by deep sedation followed by a combination therapy using verapamil and mexiletine. Interestingly, with the use of those drugs, the prominent J wave diminished. The mechanism underlying this syndrome is discussed. (PACE 2003; 26[Pt. I]:632–636)

Characteristics of Recurrent Ventricular Fibrillation Associated With Inferolateral Early Repolarization

“…Similar patients have also been previously described in case reports relating "abnormal J-wave," however, without establishing the link with early repolarization syndrome or using a control population (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). The arrhythmogenicity of this syndrome is thought to be related to heterogeneity of action potentials (spike and dome morphology in epicardial tissue) across the ventricular wall at the end of phase 1.…”

Dynamicity of the J-Wave in Idiopathic Ventricular Fibrillation With a Special Reference to Pause-Dependent Augmentation of the J-Wave

“…This seems to be in contrast to ER or J waves in healthy individuals: Ն80% subjects exhibited the same type of J-wave after an interim of 5 years (11,23,24). Whether attenuation of the J-wave amplitude by isoproterenol or quinidine is specific to J waves with idiopathic VF needs be established (8,10,(25)(26)(27).…”

“…To date, only a few such cases have been reported (22,25). Although rare, a striking pause-dependent augmentation of J waves in the inferolateral leads has been observed in a patient with Brugada syndrome (29).…”

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

“…Polymorphic VT with a normal QT interval during intervening sinus rhythm is most frequently seen in the context of acute ischemia or MI, but the QRS pattern during VT is not specific and may be seen with other cardiac disease states such as cardiomyopathy or HF or in the absence of overt cardiac disease (e.g., idiopathic polymorphic VT, catecholaminergic VT) (15,382,383). Intravenous beta blockers are useful in this context and improve mortality in the setting of recurrent polymorphic VT with AMI (384).…”