INTRODUCTION: An early repolarization (ER) pattern on electrocardiogram (ECG) sometimes has the risk of polymorphic ventricular tachycardia (PVT) or ventricular fibrillation (VF). An abnormal ER pattern can develop in various experimental or clinical situations. We experienced 4 cases of abnormal ER pattern with or without PVT during the radiofrequency (RF) ablation of the left accessory pathway. METHODS AND RESULTS: An electrophysiologic study and RF ablation were performed in 4 patients. Four patients had atrioventricular reentrant tachycardia. During RF ablation of the left accessory pathway, severe chest pain developed and was followed by abnormal J-point elevation. During the ongoing chest pain and J-point elevation, coronary angiograms showed normal findings. The chest pain and J-point elevation were followed by PVT or VF that was unresponsive to defibrillation. The PVT was spontaneously terminated and repeated. After 0.5 mg atropin was given, chest pain and ECG change disappeared. CONCLUSION: The mechanisms of ER syndrome during RF ablation might be increased vagal tone due to chest pain or direct vagal stimulation.
INTRODUCTION: An early repolarization (ER) pattern on electrocardiogram (ECG) sometimes has the risk of polymorphic ventricular tachycardia (PVT) or ventricular fibrillation (VF). An abnormal ER pattern can develop in various experimental or clinical situations. We experienced 4 cases of abnormal ER pattern with or without PVT during the radiofrequency (RF) ablation of the left accessory pathway. METHODS AND RESULTS: An electrophysiologic study and RF ablation were performed in 4 patients. Four patients had atrioventricular reentrant tachycardia. During RF ablation of the left accessory pathway, severe chest pain developed and was followed by abnormal J-point elevation. During the ongoing chest pain and J-point elevation, coronary angiograms showed normal findings. The chest pain and J-point elevation were followed by PVT or VF that was unresponsive to defibrillation. The PVT was spontaneously terminated and repeated. After 0.5 mg atropin was given, chest pain and ECG change disappeared. CONCLUSION: The mechanisms of ER syndrome during RF ablation might be increased vagal tone due to chest pain or direct vagal stimulation.
Authors: Can Hasdemir; Jimmy Jyh-Ming Juang; Sedat Kose; Umut Kocabas; Mehmet N Orman; Serdar Payzin; Hatice Sahin; Candan Celen; Emin E Ozcan; Ching-Yu Julius Chen; Ramazan Gunduz; Oguzhan E Turan; Oktay Senol; Elena Burashnikov; Charles Antzelevitch Journal: Pacing Clin Electrophysiol Date: 2018-07-16 Impact factor: 1.976