Asynchronized direct-current electrical energy causing acceleration of ventricular tachycardia

Area of Science:

• Cardiology
• Electrophysiology
• Medical Case Reports

Background:

• Ventricular tachycardia (VT) is a potentially life-threatening arrhythmia.
• Direct-current (DC) cardioversion is a common treatment for hemodynamically unstable VT.
• Proper timing of electrical shock delivery is critical to avoid proarrhythmic effects.

Observation:

• A 67-year-old male patient with VT inadvertently received an asynchronized DC shock.
• The shock was delivered during the vulnerable T-wave period of the electrocardiogram (ECG).
• This asynchronized shock resulted in acceleration of the existing VT.

Findings:

• The accelerated VT was subsequently converted to a normal sinus rhythm using a synchronized DC shock.
• This case highlights a specific instance where an asynchronized shock exacerbated a cardiac arrhythmia.
• Successful cardioversion was achieved only after synchronizing the electrical discharge.

Implications:

• Emphasizes the critical importance of synchronizing DC shocks in patients with ventricular tachycardia.
• Underscores the potential proarrhythmic dangers of asynchronized electrical cardioversion, particularly when delivered on the T-wave.
• Reinforces the need for adherence to established protocols for electrical cardioversion to ensure patient safety and treatment efficacy.