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24-04-2017 | Rhythm Puzzle - Question | Uitgave 10/2017 Open Access

Netherlands Heart Journal 10/2017

Only a boost away from re-entry

Netherlands Heart Journal > Uitgave 10/2017
E. Ströker, C. de Asmundis, G. B. Chierchia, P. Brugada
A 31-year-old patient with Brugada syndrome presented at our clinic after an electrical shock from his dual-chamber implantable cardioverter-defibrillator (ICD – Biotronik Iperia), implanted in secondary prevention of sudden cardiac death (ventricular fibrillation zone > 214 bpm, detection counter 18/24; monitor ventricular tachycardia zone > 176 bpm with supraventricular tachycardia discriminators). A regular tachycardia was stored with a total absence of atrial electrograms (defective atrial lead), but a supraventricular origin was suspected (similar QRS morphology on ventricular electrograms compared with sinus rhythm). As the electrophysiological study could not induce any arrhythmia nor evoke dual atrioventricular nodal physiology, the atrial lead was replaced in consideration of potential future events. Two months later, he received another ICD shock, again after exercise-induced palpitations with neck fullness.
Fig.  1 shows the new episode as stored in the device memory. What would be your diagnosis and your next step or treatment?


You will find the answer elsewhere in this issue.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie en de Nederlandse Hartstichting. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

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