Repetitive-incessant electrical storm triggered by early repolarization

Abstract

Early repolarization syndrome (ERS) was originally considered a normal variant with benign outcome. However, recent studies have demonstrated that it can be linked to a considerable risk of life-threatening arrhythmias and sudden cardiac death. We report a case with an extraordinary, extremely malignant clinical expression of ERS refractory to all antiarrhythmic drugs including quinidine. This case demonstrates real-time changes of dynamic electrocardiogram (ECG) preceding a polymorphic ventricular tachycardia (VT)-ventricular fibrillation (VF) and possible external factors triggering arrhythmia onset. Implantable cardioverter-defibrillator (ICD) function was terminated 6 months after implantation due to multiple-incessant electrical storm (ES). Catheter ablation was the definite treatment of this malignant entity.

Keywords: cellular electrophysiology/electropharmocology; electrophysiology-ventricular tachycardia.

Figure 1

(a) Baseline electrocardiogram (ECG) showing sinus beats with J‐points deviation from baseline of greater than 0.3 mV and smooth transition from QRS to ST segment in the inferior leads preceding the initiation of repetitive‐incessant polymorphic ventricular tachycardia. (b) Following isoprotenerol administration, rhythm was converted back to sinus as documented in continuous recording of V₁‐V₄ leads

Figure 2

ECG showing the onset of ventricular tachycardia. *denotes the similarity between the initiating beat that induces the ventricular tachycardia and the preceding isolated beat