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  • 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. 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. Holter 24 hr monitor ECG: Non-sustained VTBrain CT: negativeEEG: equivocal abnormality CMUH
  • 4. QTc : 406 ms CMUH
  • 5. CMUH
  • 6. Daily attacks of non-sustained VT101/03/18 101/03/21101/03/19 101/03/22101/03/20 CMUH
  • 7. Three Different QRS morphologies of the Triggering VPC CMUH
  • 8. Treadmill exercise test Negativefor ischemia No VT or VF was induced during TET CMUH
  • 9. CMUH
  • 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. CMUH
  • 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. LV Inferior-apico-septal locationSpontaneous VPC Pace mapping CMUH
  • 14. Purkinje potential CMUH
  • 15. Endocardial electrograms of VPC CMUH
  • 16. No more daily VT post RFCA101/03/24 ICD implantation was performed due to only one of three morphologic VPCs ablation CMUH
  • 17. After ICD implantationSpontaneous idiopathic VF with near syncopewas noted. Aborted ICD shock due tospontaneous termination. CMUH
  • 18. Disscussion
  • 19. After ablation, 24 ± 28 months, 24patients (89%) in 27 patients had norecurrence of ventricular fibrillationwithout drug. CMUH
  • 20. Characteristics of PatientsTwenty-seven consecutive patientsunderwent attempted ablation of primaryidiopathic VF in 6 centers CMUH
  • 21. CMUH
  • 22. VPC Patient numbermorphology RVOT 4 RBBB 10 LBBB 13 Both 4 CMUH
  • 23. CMUH
  • 24. CMUH
  • 25. CMUH
  • 26. CMUH
  • 27. CMUH
  • 28. CMUH
  • 29. CMUH
  • 30. CMUH
  • 31. Thank you for your attention!