Circulation, Vol 75, 809-816, Copyright © 1987 by American Heart Association
B Belhassen, I Shapira, D Shoshani, A Paredes, H Miller and S Laniado
Ventricular fibrillation in patients without recognizable heart disease is
uncommon and electrophysiologic data on such patients is limited. Over a 7
year period, five patients (three men and two women, ranging in age from 24
to 52 years) without demonstrable heart disease underwent
electrophysiologic studies with pharmacologic drug testing because of
single (four patients) or multiple (one patient) documented episodes of
ventricular fibrillation. The arrhythmic event was unrelated to myocardial
ischemia or infarction, metabolic or electrolyte disturbances, drug
toxicity, preexcitation, or prolonged QT syndromes. In all three patients
receiving no antiarrhythmic drugs and in two pretreated with amiodarone, a
rapid poorly tolerated ventricular tachyarrhythmia requiring cardioversion
was induced by programmed ventricular stimulation with up to two
extrastimuli. In all instances, addition of either oral quinidine or oral
disopyramide prevented the induction of sustained ventricular arrhythmias.
All five patients were placed on antiarrhythmic drug regimens found
effective during electrophysiologic studies and remained asymptomatic
during follow-up periods ranging from 12 to 93 (mean 52) months. We
conclude that in the patients with idiopathic ventricular fibrillation in
our study: programmed ventricular stimulation reliably replicated the
spontaneous arrhythmia, class I antiarrhythmic agents effectively prevented
induction of the arrhythmia in the laboratory, and in contrast to the
severity of the presenting arrhythmia, a benign clinical course was
observed during long-term therapy with class I antiarrhythmic agents.
ARTICLES
Idiopathic ventricular fibrillation: inducibility and beneficial effects of class I antiarrhythmic agents
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