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(Circulation. 2002;106:521.)
© 2002 American Heart Association, Inc.

Images in Cardiovascular Medicine

Ventricular Fibrillation During Swimming in a Patient With Long-QT Syndrome

Peter Ott, MD; Frank I. Marcus, MD; Arthur J. Moss, MD

From the University of Arizona Health Sciences Center (P.O., F.I.M.), Tucson; and University of Rochester School of Medicine and Dentistry (A.J.M.), Rochester, NY.

Correspondence to Peter Ott, MD, Assistant Professor of Medicine, University of Arizona Health Sciences Center, Department of Medicine, Sarver Heart Center, 1501 N Campbell Ave, Tucson, AZ 85724. E-mail ottp{at}u.arizona.edu

A 32-year-old woman was diagnosed with long-QT syndrome in 1997. One year later, a single-chamber implantable cardioverter-defibrillator (ICD) was implanted after multiple episodes of syncope. She has had no syncope or ICD discharge during the last 19 months.

She passed out while swimming. She was pulled from the water semiconscious by her 13-year-old daughter and did not remember receiving an ICD shock. A 12-lead ECG showed a QT interval of 600 ms (Figure 1). The ICD interrogation revealed ventricular fibrillation followed by correct arrhythmia detection and successful termination by defibrillation through the device (Figure 2). This occurred at the time she was swimming.

View larger version (109K): [in this window] [in a new window]   Figure 1. Twelve-lead surface ECG (25 mm/s; 1 mV/cm) showing sinus rhythm at a rate of 60 bpm. There is a markedly prolonged QT interval (600 ms; best seen in leads I and aVL) with a broad-based T wave characteristic of the long-QT 1 syndrome.

View larger version (13K): [in this window] [in a new window]   Figure 2. Displayed are the ventricular electrograms (recorded from the shock electrode) from the episode during swimming (25 mm/s). The onset of ventricular fibrillation appears to be preceded by premature ventricular beats and a brief run of ventricular tachycardia.

Swimming appears to be a specific trigger of arrhythmias in long-QT 1 syndrome. Why swimming has such a specific correlation with the long-QT 1 syndrome is unclear. It is tempting, however, to speculate that this activity may provide particularly intense sympathetic stimulation due to physical exertion, possibly combined with fear.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ott, P. Articles by Moss, A. J. Search for Related Content PubMed PubMed Citation Articles by Ott, P. Articles by Moss, A. J. Related Collections Ablation/ICD/surgery Arrhythmias, clinical electrophysiology, drugs