Noncoronary ST elevation and polymorphic ventricular tachycardia during left-sided accessory pathway ablation

Area of Science:

• Cardiology
• Electrophysiology

Background:

• Early repolarization (ER) patterns on electrocardiograms (ECGs) are sometimes associated with risks of polymorphic ventricular tachycardia (PVT) and ventricular fibrillation (VF).
• Abnormal ER patterns can manifest in diverse clinical scenarios.

Observation:

• Four patients undergoing radiofrequency (RF) ablation for left accessory pathways experienced severe chest pain and abnormal J-point elevation during the procedure.
• Coronary angiograms revealed normal findings despite ongoing chest pain and ECG changes.

Findings:

• The chest pain and J-point elevation were followed by episodes of PVT or VF, which were initially unresponsive to defibrillation.
• Administration of atropine (0.5 mg) led to the resolution of chest pain and ECG abnormalities.

Implications:

• Increased vagal tone, potentially due to chest pain or direct vagal stimulation, may be the mechanism underlying ER syndrome during RF ablation.
• These findings highlight a potential complication of RF ablation and suggest a therapeutic approach.