[Recurrent ventricular fibrillation, right bundle-branch block and persistent ST segment elevation in V1-V3: a new...

In this report we describe a patient with a rare arrhythmic syndrome, recently reported and characterized by aborted sudden death, right bundle branch block and persistent ST segment elevation in precordial leads. The patient is a 65-year-old man, who had survived recurrent episodes of ventricular fibrillation (VF). The ECG during sinus rhythm revealed the coexistence of right bundle branch block and persistent ST segment elevation (1-4 mm) in leads V1-V3. The clinical and laboratory investigations, including echocardiography, cardiac catheterization and right endomyocardial biopsy, could not identify any significant morphological and functional cardiac abnormalities. The presence of late potentials (high gain ECG), and the inducibility of VF during the electrophysiological study, suggest a functional reentry as arrhythmogenic substratum. During a 60-month follow-up period, high-dose amiodarone per os, and subsequent AICD therapy successfully treated recurrent VF episodes. This clinical case confirms the existence of a new idiopathic malignant arrhythmic syndrome. Aggressive antiarrhythmic therapy seems fundamental in this type of patients.