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.
Keywords
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References
- Idiopathic Ventricular Fibrillation: Role of Purkinje System and Microstructural Myocardial Abnormalities.JACC Clin Electrophysiol. 2020; 6: 591-608
- Short-coupled Idiopathic ventricular fibrillation: A literature review with new extended follow-Up.JACC Clin Electrophysiol. 2022 Apr 28; (S2405-500X(22)00335-8Online ahead of print)https://doi.org/10.1016/j.jacep.2022.04.013
- Syncope in Brugada syndrome: prevalence, clinical significance, and clues from history taking to distinguish arrhythmic from nonarrhythmic causes.Heart Rhythm. 2015; 12: 367-375
- Age of first faint in patients with vasovagal syncope. Investigators of the Syncope Symptom Study and the Prevention of Syncope Trial.J Cardiovasc Electrophysiol. 2006; 17: 49-54
- Short-coupled ventricular fibrillation represents a distinct phenotype among latent causes of unexplained cardiac arrest: a report from the CASPER registry.Eur Heart J. 2021; 42: 2827-2838
- Sex differences in the origin of Purkinje ectopy-initiated idiopathic ventricular fibrillation.Heart Rhythm. 2021; 18: 1647-1654
- Long-term follow-up of idiopathic ventricular fibrillation ablation: a multicenter study.J Am Coll Cardiol. 2009; 54: 522-528
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