BACKGROUND: Bidirectional ventricular tachycardia is a rare form of ventricular arrhythmia, characterized by a changing of the mean QRS axis of 180 degrees. Digitalis toxicity is the most common cause of bidirectional ventricular tachycardia; other causes include myocarditis, aconite toxicity, metastatic cardiac tumor, myocardial infarction, and cardiac channelopathies. CASE REPORT: A 73-year-old male with hypertension and a pacemaker implanted for sick sinus syndrome presented with a complaint of substernal chest pressure for several days. He also stated he had had an episode of near syncope. The patient's physical examination was unremarkable; however, electrocardiogram demonstrated sustained bidirectional ventricular tachycardia. Echocardiogram showed severe anterior wall hypokinesis and an estimated ejection fraction of 35%, as well as an apical ventricular aneurysm. Electrophysiology study showed that the apical ventricular aneurysm was the site of the bidirectional arrhythmia. The patient was successfully treated with ventricular tachycardia ablation. CONCLUSION: This case is a unique example of a patient with bidirectional ventricular tachycardia originating from an apical left ventricular aneurysm that was treated successfully by ablation.
BACKGROUND: Bidirectional ventricular tachycardia is a rare form of ventricular arrhythmia, characterized by a changing of the mean QRS axis of 180 degrees. Digitalis toxicity is the most common cause of bidirectional ventricular tachycardia; other causes include myocarditis, aconite toxicity, metastatic cardiac tumor, myocardial infarction, and cardiac channelopathies. CASE REPORT: A 73-year-old male with hypertension and a pacemaker implanted for sick sinus syndrome presented with a complaint of substernal chest pressure for several days. He also stated he had had an episode of near syncope. The patient's physical examination was unremarkable; however, electrocardiogram demonstrated sustained bidirectional ventricular tachycardia. Echocardiogram showed severe anterior wall hypokinesis and an estimated ejection fraction of 35%, as well as an apical ventricular aneurysm. Electrophysiology study showed that the apical ventricular aneurysm was the site of the bidirectional arrhythmia. The patient was successfully treated with ventricular tachycardia ablation. CONCLUSION: This case is a unique example of a patient with bidirectional ventricular tachycardia originating from an apical left ventricular aneurysm that was treated successfully by ablation.
Authors: Kimmo Kontula; Päivi J Laitinen; Annukka Lehtonen; Lauri Toivonen; Matti Viitasalo; Heikki Swan Journal: Cardiovasc Res Date: 2005-08-15 Impact factor: 10.787
Authors: Thomas M Roston; Jeffrey M Vinocur; Kathleen R Maginot; Saira Mohammed; Jack C Salerno; Susan P Etheridge; Mitchell Cohen; Robert M Hamilton; Andreas Pflaumer; Ronald J Kanter; James E Potts; Martin J LaPage; Kathryn K Collins; Roman A Gebauer; Joel D Temple; Anjan S Batra; Christopher Erickson; Maria Miszczak-Knecht; Peter Kubuš; Yaniv Bar-Cohen; Michal Kantoch; Vincent C Thomas; Gabriele Hessling; Chris Anderson; Ming-Lon Young; Michel Cabrera Ortega; Yung R Lau; Christopher L Johnsrude; Anne Fournier; Prince J Kannankeril; Shubhayan Sanatani Journal: Circ Arrhythm Electrophysiol Date: 2015-02-24