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Polymorphic Ventricular Tachycardia Induced by Left Ventricular Pacing

2004; Lippincott Williams & Wilkins; Volume: 109; Issue: 23 Linguagem: Inglês

10.1161/01.cir.0000130731.98722.f8

1524-4539

Máximo Rivero‐Ayerza, Marc Vanderheyden, Sofie Verstreken, Marc De Zutter, Peter Geelen, Pedro Brugada,

Cardiomyopathy and Myosin Studies

HomeCirculationVol. 109, No. 23Polymorphic Ventricular Tachycardia Induced by Left Ventricular Pacing Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBPolymorphic Ventricular Tachycardia Induced by Left Ventricular Pacing Máximo Rivero-Ayerza, MD, Marc Vanderheyden, MD, Sofie Verstreken, MD, Marc de Zutter, RN, Peter Geelen, MD and Pedro Brugada, MD Máximo Rivero-AyerzaMáximo Rivero-Ayerza From the Cardiovascular Center, Onze Lieve Vrouw (OLV) Ziekenhuis, Aalst, Belgium. , Marc VanderheydenMarc Vanderheyden From the Cardiovascular Center, Onze Lieve Vrouw (OLV) Ziekenhuis, Aalst, Belgium. , Sofie VerstrekenSofie Verstreken From the Cardiovascular Center, Onze Lieve Vrouw (OLV) Ziekenhuis, Aalst, Belgium. , Marc de ZutterMarc de Zutter From the Cardiovascular Center, Onze Lieve Vrouw (OLV) Ziekenhuis, Aalst, Belgium. , Peter GeelenPeter Geelen From the Cardiovascular Center, Onze Lieve Vrouw (OLV) Ziekenhuis, Aalst, Belgium. and Pedro BrugadaPedro Brugada From the Cardiovascular Center, Onze Lieve Vrouw (OLV) Ziekenhuis, Aalst, Belgium. Originally published15 Jun 2004https://doi.org/10.1161/01.CIR.0000130731.98722.F8Circulation. 2004;109:2924–2925A 67-year-old woman with advanced heart failure accompanying idiopathic dilated cardiomyopathy had a broad QRS complex on the ECG and significant inter- and intraventricular asynchrony as shown by tissue Doppler echocardiography. She had no history of syncope, no documentation of any ventricular arrhythmias, and no metabolic or electrolyte abnormalities. Implantation of a biventricular pacemaker was indicated. When left ventricular stimulation was started, she developed multiple polymorphic ventricular extrasystoles (Figure 1) and polymorphic ventricular tachycardias. During the left ventricular lead threshold testing, the first noncaptured stimulus generated a "long-short"–like sequence that triggered a sustained episode of torsade de pointes that required electrical cardioversion (Figure 2). No ventricular arrhythmias were induced when the right ventricle or both ventricles were paced simultaneously. Download figureDownload PowerPointFigure 1. Initiation of left ventricular pacing immediately generates ventricular extrasystoles and nonsustained polymorphic ventricular tachycardia. Top panel, ECG lead I. Bottom panel, Arterial pressure monitoring. Vertical lines mark 2-second intervals.Download figureDownload PowerPointFigure 2. Left ventricular pacing during threshold testing. Note that a single noncaptured stimulus generates a long-short–like sequence that triggers a sustained episode of torsade de pointes. Organization is as in Figure 1.Heterogeneity within the ventricular wall is a major mechanism of ventricular arrhythmias in primary electrical disorders such as Brugada syndrome and the long-QT syndrome. But acquired forms also exist, such as drug-induced torsade de pointes, drug-induced Brugada syndrome, and the entity shown here, left ventricular pacing–induced polymorphic ventricular tachycardia.*The first 2 authors contributed equally to this work.The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke's Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.FootnotesCorrespondence to Marc Vanderheyden, MD, Cardiovascular Center, OLV Ziekenhuis, Moorselbaan 164, 9300 Aalst, Belgium. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Lador A and Valderrábano M (2020) QT interval prolongation and torsade de pointes induced by left ventricular pacing rescued by His bundle pacing, HeartRhythm Case Reports, 10.1016/j.hrcr.2020.02.010, 6:6, (325-328), Online publication date: 1-Jun-2020. Sapp J, Parkash R, Wells G, Yetisir E, Gardner M, Healey J, Thibault B, Sterns L, Birnie D, Nery P, Sivakumaran S, Essebag V, Dorian P and Tang A (2017) Cardiac Resynchronization Therapy Reduces Ventricular Arrhythmias in Primary but Not Secondary Prophylactic Implantable Cardioverter Defibrillator Patients, Circulation: Arrhythmia and Electrophysiology, 10:3, Online publication date: 1-Mar-2017. 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MYKYTSEY A, MAHESHWARI P, DHAR G, RAZMINIA M, ZHEUTLIN T, WANG T and KEHOE R (2005) Ventricular Tachycardia Induced by Biventricular Pacing in Patient with Severe Ischemic Cardiomyopathy, Journal of Cardiovascular Electrophysiology, 10.1111/j.1540-8167.2005.40764.x, 16:6, (655-658) Stupakov S (2015) CARDIOSTIMULATION AND RHYTHM DISORDERS IN PATIENTS WITH CHRONIC HEART FAILURE, Cardiovascular Therapy and Prevention, 10.15829/1728-8800-2015-3-89-94, 14:3, (89-94) June 15, 2004Vol 109, Issue 23 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000130731.98722.F8PMID: 15197157 Originally publishedJune 15, 2004 PDF download Advertisement