Pulseless Electric Activity with Pre-Excitation

Int Heart J. 2019 Mar 20;60(2):470-473. doi: 10.1536/ihj.18-546. Epub 2019 Feb 8.

Abstract

A 41-year-old man developed cardiac arrest. A resting 12-lead electrocardiogram showed a delta wave, suggestive of preexcitation syndrome. An electrophysiological test revealed the existence of inducible atrial fibrillation and a fasciculoventricular accessory pathway (FVAP). After these examinations, idiopathic ventricular arrhythmia was suspected. For evaluating concealed Brugada syndrome, pilsicainide was administered, which diminished the delta wave and no Brugada-like electrocardiogram was observed. Ventricular double extra-stimulation from the RV apex easily induced VF, which could not be defibrillated by an external defibrillator, and later stopped spontaneously. These results established the diagnosis of FVAP and idiopathic VF, and not pre-excited atrial fibrillation or Brugada syndrome.

Keywords: Brugada syndrome; Delta wave; Pre-excited atrial fibrillation; Sudden cardiac arrest.

Publication types

  • Case Reports

MeSH terms

  • Accessory Atrioventricular Bundle* / diagnosis
  • Accessory Atrioventricular Bundle* / physiopathology
  • Accessory Atrioventricular Bundle* / therapy
  • Adult
  • Brugada Syndrome / diagnosis*
  • Death, Sudden, Cardiac / etiology
  • Death, Sudden, Cardiac / prevention & control
  • Defibrillators
  • Diagnosis, Differential
  • Electric Countershock / methods*
  • Electrocardiography / methods*
  • Electrophysiologic Techniques, Cardiac / methods
  • Humans
  • Male
  • Pre-Excitation Syndromes* / diagnosis
  • Pre-Excitation Syndromes* / physiopathology
  • Pre-Excitation Syndromes* / therapy
  • Remission, Spontaneous
  • Treatment Failure
  • Ventricular Fibrillation / therapy*