Case conference-vt

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Case conference-vt

  1. 1. Case ConferenceRecurrent syncope in a 23-year-old Mongolian woman 吳宏彬醫師 中國醫藥大學附設醫院心臟科
  2. 2. 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
  3. 3. Holter 24 hr monitor ECG: Non-sustained VTBrain CT: negativeEEG: equivocal abnormality CMUH
  4. 4. QTc : 406 ms CMUH
  5. 5. CMUH
  6. 6. Daily attacks of non-sustained VT101/03/18 101/03/21101/03/19 101/03/22101/03/20 CMUH
  7. 7. Three Different QRS morphologies of the Triggering VPC CMUH
  8. 8. Treadmill exercise test Negativefor ischemia No VT or VF was induced during TET CMUH
  9. 9. CMUH
  10. 10. 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
  11. 11. CMUH
  12. 12. Basic intervalsSinus CL 857 msQRS 87 msAH 99 msHV 43 msSNRT 600=1103 ms 500=1000 msCL-1:1 AV 420 msconductionCL-AVB 410 msAEST-CL 500 msERP-AVN 370 msCL-1:1Ret FP No VA CMUH
  13. 13. LV Inferior-apico-septal locationSpontaneous VPC Pace mapping CMUH
  14. 14. Purkinje potential CMUH
  15. 15. Endocardial electrograms of VPC CMUH
  16. 16. No more daily VT post RFCA101/03/24 ICD implantation was performed due to only one of three morphologic VPCs ablation CMUH
  17. 17. After ICD implantationSpontaneous idiopathic VF with near syncopewas noted. Aborted ICD shock due tospontaneous termination. CMUH
  18. 18. Disscussion
  19. 19. After ablation, 24 ± 28 months, 24patients (89%) in 27 patients had norecurrence of ventricular fibrillationwithout drug. CMUH
  20. 20. Characteristics of PatientsTwenty-seven consecutive patientsunderwent attempted ablation of primaryidiopathic VF in 6 centers CMUH
  21. 21. CMUH
  22. 22. VPC Patient numbermorphology RVOT 4 RBBB 10 LBBB 13 Both 4 CMUH
  23. 23. CMUH
  24. 24. CMUH
  25. 25. CMUH
  26. 26. CMUH
  27. 27. CMUH
  28. 28. CMUH
  29. 29. CMUH
  30. 30. CMUH
  31. 31. Thank you for your attention!

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