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Red Flags in Syncope: Clues for the Diagnosis of Idiopathic Ventricular Fibrillation

      HIGHLIGHTS

      • Idiopathic ventricular fibrillation is responsible for ≈ 5-7% of aborted cardiac arrest, mainly striking subjects in their 40’s.
      • Syncope caused by short-coupled rapid polymorphic ventricular tachycardia is frequently noted in patients’ past history.
      • Clinical clues suggest that syncope has an arrhythmic rather than a neurally-mediated origin.
      • ECG documentation of short-coupled premature ventricular contractions after a syncopal event highly suggests its arrhythmic origin in the setting of idiopathic ventricular fibrillation.

      UNSTRUCTURED ABSTRACT

      Idiopathic ventricular fibrillation is responsible for ≈ 5-7% of aborted cardiac arrest, mainly striking subjects in their 40’s.
      Syncope caused by short-coupled rapid polymorphic ventricular tachycardia is frequently noted in patients’ past history. However, a diagnosis of neurally-mediated syncope, the most frequently cause of syncope in the young, is often erroneously made. Clinical clues suggest that syncope has an arrhythmic rather than a neurally-mediated origin. In addition, the presence of premature ventricular contractions on an ECG recorded shortly after a syncopal event have uppermost importance in establishing the cause of syncope. Although such extrasystoles are frequently benign, especially when associated with a long coupling interval, they also may suggest a malignant origin when closely coupled to the preceding complex with short coupling intervals (usually less than 350ms). These arrhythmias mainly originate from the Purkinje system (usually the right ventricle in men and the left ventricle in women) and favorably respond to quinidine as well as to ablation therapy targeting Purkinje-fibers ectopic activity.

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