Related Experiment Videos
[Should protocol of programmed ventricular stimulation be adapted to each patient? ]
B Brembilla-Perrot1, P Houplon, L Jacquemin
1Service de cardiologie A, CHU Brabois, Vandaoeuvre.
Archives Des Maladies Du Coeur Et Des Vaisseaux
|November 1, 1996
Summary
This case study details a 56-year-old patient with undetermined wide QRS complex tachycardia. Programmed electrical stimulation, particularly with isoproterenol, successfully induced sustained monomorphic ventricular tachycardia, clarifying the diagnosis.
Area of Science:
- Clinical Cardiology
- Electrophysiology
- Critical Care Medicine
Background:
- A 56-year-old patient presented with complex wide QRS complex tachycardia that was difficult to ascertain.
- The patient experienced concurrent atrial flutter with left bundle branch block, complicating the diagnostic picture.
Observation:
- Initial programmed ventricular stimulation with three extrastimuli induced non-specific ventricular flutter.
- Following resuscitation from an undocumented cardiac arrest, a second electrophysiological study was performed.
- Modified stimulation protocols, including low-dose isoproterenol and a single extrastimulus, were necessary to elicit the arrhythmia.
Findings:
- Unsustained polymorphic ventricular tachycardia was observed with two extrastimuli.
- Sustained monomorphic ventricular tachycardia at a rate of 240/min was reproducibly triggered using a single extrastimulus during isoproterenol infusion.
- This confirmed ventricular tachycardia as the underlying mechanism of the patient's initial complex tachycardia.
Implications:
- This case highlights the utility of advanced electrophysiological techniques, including pharmacologic provocation, in diagnosing challenging tachycardia mechanisms.
- Understanding the specific type of ventricular tachycardia is crucial for appropriate management and preventing future cardiac events.
- The findings underscore the importance of thorough electrophysiological assessment in patients with unexplained wide QRS complex tachycardias, especially after cardiac arrest.