Case conference-vt
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Transcript of Case conference-vt
Case Conference
吳宏彬醫師中國醫藥大學附設醫院心臟科
Recurrent syncope in a 23-year-old Mongolian woman
CMUH
History
23-year-old Mongolian woman presented with recurrent syncope in recent 2 years.
Syncope preceded with short of breath and palpitation
Witnessed trismus and seizure before fainting
Mother died suddenly at her twenties
CMUH
Holter 24 hr monitor ECG: Non-sustained VT
Brain CT: negative
EEG: equivocal abnormality
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QTc : 406 ms
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Daily attacks of non-sustained VT101/03/18
101/03/19
101/03/20
101/03/21
101/03/22
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Three Different QRS morphologies of the Triggering VPC
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Treadmill exercise test
Negative for ischemiaNo VT or VF was induced during TET
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CMUH
Sudden Cardiac Death in Young Coronary artery anomalies, LAD bridge, CAD Primary electrical diseases:
WPW Long QT syndrome Catecholaminergic polymorphic VT Brugada syndrome Short QT syndrome Idiopathic VF Neurologic problems
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Basic intervalsSinus CL 857 ms
QRS 87 ms
AH 99 ms
HV 43 ms
SNRT 600=1103 ms 500=1000 ms
CL-1:1 AV conduction
420 ms
CL-AVB 410 ms
AEST-CL 500 ms
ERP-AVN 370 ms
CL-1:1Ret FP No VA
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Spontaneous VPC Pace mapping
LV Inferior-apico-septal location
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Purkinje potential
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Endocardial electrograms of VPC
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No more daily VT post RFCA
101/03/24
ICD implantation was performed due to only one of three morphologic VPCs ablation
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After ICD implantation
Spontaneous idiopathic VF with near syncope was noted. Aborted ICD shock due to spontaneous termination.
Disscussion
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After ablation, 24 ± 28 months, 24 patients (89%) in 27 patients had no recurrence of ventricular fibrillation without drug.
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Characteristics of Patients
Twenty-seven consecutive patients underwent attempted ablation of primary idiopathic VF in 6 centers
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CMUH
VPC morphology
Patient number
RVOT 4
RBBB 10
LBBB 13
Both 4
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Thank you for your attention!