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Persistent left superior vena cava in a man with ventricular fibrillation
Insights
Recurrent syncope and sudden cardiac arrest were linked to an isolated left superior vena cava. This congenital heart abnormality may predispose individuals to life-threatening ventricular fibrillation.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Congenital Heart Disease
Background:
- Sudden cardiac arrest (SCA) and recurrent syncope are critical clinical events.
- Ventricular fibrillation (VF) is a primary cause of SCA.
- Congenital heart abnormalities can predispose individuals to arrhythmias.
Observation:
- A patient presented with recurrent syncope and sudden cardiac arrest.
- The patient had ventricular fibrillation unrelated to acute myocardial infarction.
- Electrophysiologic study revealed an isolated left superior vena cava (LSVC).
Findings:
- Programmed ventricular stimulation readily induced ventricular fibrillation (VF).
- VF induction occurred both off and during serial electropharmacologic testing.
- These results establish a link between LSVC and inducible VF.
Implications:
- Isolated left superior vena cava may be an independent risk factor for sudden cardiac death.
- This finding highlights the importance of considering congenital anomalies in unexplained ventricular arrhythmias.
- Further research into the arrhythmogenic mechanisms of LSVC is warranted.
Abstract:
A patient who had recurrent syncope and an episode of sudden cardiac arrest due to ventricular fibrillation unassociated with acute myocardial infarction is presented. An isolated left superior vena cava was discovered during electrophysiologic study. Ventricular fibrillation was readily induced by programmed ventricular stimulation in the initial (off the drugs) and subsequent serial electropharmacologic testings. These findings suggest that ventricular fibrillation may be the cause of sudden death in patients with this congenital abnormality.