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Polymorphic ventricular tachycardia induced during tilt table testing in a patient with syncope and probable
K A Gatzoulis1, I E Mamarelis, T Apostolopoulos
1Department of Cardiology, Hippokration Hospital University of Athens, Greece.
Pacing and Clinical Electrophysiology : PACE
|May 1, 1995
Summary
A 44-year-old man experienced life-threatening polymorphic ventricular tachycardia during tilt table testing. This arrhythmia, induced by isoproterenol, led to a diagnosis of sick sinus syndrome.
Area of Science:
- Cardiology
- Electrophysiology
- Clinical Medicine
Background:
- Syncope is a common clinical presentation requiring thorough investigation.
- Tilt table testing is a diagnostic tool used to evaluate unexplained syncope.
- Isoproterenol infusion is sometimes used during tilt table testing to provoke arrhythmias.
Observation:
- A 44-year-old male patient presented with syncope.
- During tilt table testing with isoproterenol infusion (2 micrograms/min), the patient developed polymorphic ventricular tachycardia.
- No preceding cardiac ischemia, QTc prolongation, or electrolyte disturbances were identified.
Findings:
- The polymorphic ventricular tachycardia was not inducible by programmed ventricular stimulation or exercise testing.
- Electrophysiological and clinical findings supported the diagnosis of sick sinus syndrome.
- Isoproterenol-induced polymorphic ventricular tachycardia during tilt table testing is a rare but critical event.
Implications:
- This case highlights the potential for life-threatening arrhythmias during provocative testing for syncope.
- Sick sinus syndrome can manifest with diverse and severe cardiac events.
- Careful patient selection and monitoring are crucial during tilt table testing, especially with pharmacologic provocation.