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Related Experiment Videos

Ventricular fibrillation refractory to ICD therapy.

Masayuki Yasuda1, Yuji Nakazato, Akitoshi Sasaki

  • 1Division of Cardiology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan.

Internal Medicine (Tokyo, Japan)
|September 15, 2005
PubMed
Summary

A young boy with unexplained syncope died suddenly despite an implantable cardioverter-defibrillator (ICD). Ventricular fibrillation (VF) occurred, but the ICD failed to convert it, suggesting possible myocardial damage or increased defibrillation threshold.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Sudden Cardiac Death

Background:

  • Recurrent syncope in adolescents can indicate underlying cardiac conditions.
  • Electrocardiogram (ECG) abnormalities, including T wave inversion and abnormal q waves, may suggest myocardial disease.
  • Sudden cardiac death in families with similar ECG findings warrants investigation.

Observation:

  • A 14-year-old male presented with recurrent syncope and concerning ECG findings (undetermined QRS axis, T wave inversion, abnormal q waves).
  • Extensive investigations, including morphological examination and programmed ventricular stimulation, failed to identify the cause of syncope or induce arrhythmias.
  • Signal-averaged ECG revealed ventricular late potentials, a potential marker for arrhythmogenic substrate.

Findings:

Related Experiment Videos

  • Despite prophylactic implantation of an implantable cardioverter-defibrillator (ICD) due to a family history of sudden death, the patient experienced a fatal event.
  • The ICD recorded ventricular fibrillation (VF), which was refractory to multiple cardioversion attempts.
  • The failure of ICD therapy suggests potential progression of myocardial damage or an elevated defibrillation threshold.

    • Implications:

    • This case highlights the challenges in diagnosing and managing syncope in adolescents with unexplained ECG abnormalities.
    • Refractory ventricular fibrillation despite ICD therapy underscores the need for further research into advanced defibrillation strategies.
    • Understanding the progression of myocardial damage and factors influencing defibrillation thresholds is crucial for improving outcomes in patients at risk for sudden cardiac death.