[Idiopathic ventricular fibrillation]

In 1 to 8% of survivors of syncopal ventricular fibrillation, it is impossible to identify a structural cardiac abnormality. Idiopathic ventricular fibrillation, a diagnosis of exclusion, is a term which includes a variety of diseases. This article describes several well defined electro-clinical entities: Brugada's syndrome, torsades de pointes with a short coupling interval, catecholinergic polymorphic ventricular tachycardia and the acquired long QT syndrome. In the majority of these cases, despite the fact that their physiopathology is not fully understood, the management is clear-cut. However, in a large number of patients, the choice between pharmacological treatment and the implantation of an automatic defibrillator remains difficult. Molecular biological studies and strict clinical investigation, standardised with the help of networks, should provide a rational approach to the treatment of idiopathic ventricular fibrillation.