1. Case Conference
Recurrent 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 VT
Brain CT: negative
EEG: equivocal abnormality
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4. QTc : 406 ms
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5. CMUH

6. Daily attacks of non-sustained VT
101/03/18 101/03/21
101/03/19 101/03/22
101/03/20
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7. Three Different QRS morphologies of
the Triggering VPC
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8. Treadmill exercise test
 Negativefor ischemia
 No VT or VF was induced during TET
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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
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11. CMUH

12. Basic intervals
Sinus CL 857 ms
QRS 87 ms
AH 99 ms
HV 43 ms
SNRT 600=1103 ms 500=1000 ms
CL-1:1 AV 420 ms
conduction
CL-AVB 410 ms
AEST-CL 500 ms
ERP-AVN 370 ms
CL-1:1Ret FP No VA CMUH

13. LV Inferior-apico-septal location
Spontaneous VPC Pace mapping
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14. Purkinje potential
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15. Endocardial electrograms of VPC
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16. No more daily VT post RFCA
101/03/24
ICD implantation was performed due
to only one of three morphologic
VPCs ablation
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17. After ICD implantation
Spontaneous idiopathic VF with near syncope
was noted. Aborted ICD shock due to
spontaneous termination.
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18. Disscussion

19. After ablation, 24 ± 28 months, 24
patients (89%) in 27 patients had no
recurrence of ventricular fibrillation
without drug.
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20. Characteristics of Patients
Twenty-seven consecutive patients
underwent attempted ablation of primary
idiopathic VF in 6 centers
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22. VPC Patient number
morphology
RVOT 4
RBBB 10
LBBB 13
Both 4
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31. Thank you for your attention!