Ventricular fibrillation during electrical cardioversion of pre-excited atrial fibrillation

Abstract

The Wolff-Parkinson-White syndrome can rarely present with pre-excited atrial fibrillation. In this condition the short refractory period of the accessory pathway can lead to rapid atrioventricular conduction. There is then a danger that at high heart rates the irregular broad complex tachycardia that results can deteriorate into ventricular fibrillation. The initial management of patients presenting in pre-excited atrial fibrillation requires cardioversion to sinus rhythm. This can be performed by DC cardioversion or pharmacological means. This paper describes the case of a patient presenting in pre-excited atrial fibrillation where electrical DC cardioversion lead to transient iatrogenic ventricular fibrillation.

The Safety and Efficacy of Ibutilide in Children and in Patients with Congenital Heart Disease

“…A recent study by Botkin et al found a complication rate of 2.6% 18 . Risks include stunning (which can occur after cardioversion by any method 19 ), failure to synchronize and thereby cause ventricular fibrillation, 20 aspiration pneumonia, pulmonary edema, and even fire (albeit during a defibrillation attempt) 21 …”

Termination of re‐entrant atrial tachycardia via optogenetic stimulation with optimized spatial targeting: insights from computational models

“…Potential treatments include cardioversion and catheter ablation but both options have shortcomings. In addition to the fact that it provides only temporary relief from symptoms, external cardioversion is painful (Adlam & Azeem, ) and necessitates anaesthesia, which is expensive, time consuming, and can lead to complications (Boodhoo et al . ).…”

Cardioversion

“… Separate input and output lines are required for the defibrillator to synchronise a shock. Pads and monitoring leads both need to be attached, and lead II should be selected as the input line. The ‘synch’ button should be pressed, and small symbols should designate each QRS complex on the defibrillation monitor. R on T phenomenon and ventricular fibrillation have been described as complications of synchronised shock In this event, administer a 200 J unsynchronised shock. …”

“…lar fibrillation have been described as complications of synchronised shock. 25,26 • In this event, administer a 200 J unsynchronised shock.…”