https://www.researchgate.net/publication/301455063_Idiopathic_ventricular_storm
I have posted the ECG of the ventricular arrhythmia that I am trying to work out. The subject is young and has normal MRI, SAECG, ETT, adrenaline and ajmaline tests are negative.
Can anyone explain what is really going on?
Working Paper Idiopathic ventricular storm
The next step could be an electrophysiology study to understand what is the origin of the ventricular tachycardia.
Hi, Yes that would be an ideal next step but oddly the patient declined it and did not want further investigations or treatment. Based on the rhythm strip, what can be stipulated about the origin of the rhythm. It seems to be some form of wandering circuit or possibly a wandering physiological block. I don't know if that makes any sense.
The patients seems to survive on this. Have you excluded the possibility of a more benign arrhythmia such aberrant A-V pathway? What rhythm after starts up DC conversion?
Please find post cardioversion ECGs, ambulance ECG and baseline ECG.
Exercise ECG was normal, and QTc intervals were normal.
Adenosine challenge did not reveal any accessory pathway.
IN my opinion, electrophysiological testing will reveal and aberrant A-V pathway that can be ablated to obtain a permanent cure.
It is very unfortunate that the patient decided not to stay for complete investigations and hence no EP study.
I am a very old cardiologist with more than 20.000 acute patients in my CCU 1970-1990.In my praxis I had not such an unexplained case, but I remember two similar ones. Of cource, the aetiologies were quiet different, not "idiopathic" like this one: Nr. 1: young male with more than 150 dc-shock attempts due to repetitive ventricular storm. At last he had MI due to myocardial bridge ("Myocardial infarction without occlusion, dominant left CA and anomalous bridge", A.N. and coll., VII Serbo-Croatian cardiological meeting, Zagreb, 1975). Nr 2 case was a 40 yr old female, earlier she had only ventricurar ES and no other cardiac or metabolic abnormalities. In an unprovoked attack of (I called him) ventricular delirium like this one lasting for hours with many DC shocks, Xylocain etc she entered asystole and died. Autopsy revealed an extremely rare " diffuse lipomatosis cordis destruens" with no one part of normal myocardium except interventricurar septum ! ( not published)
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