Fatal Bidirectional and Polymorphic Ventricular Tachycardia With Terminal Depolarization Abnormality in a Child
A 14-year-old boy was admitted after resuscitation from cardiac arrest that occurred while chasing a ball at school. An initial ECG showed incessant bidirectional and polymorphic ventricular tachycardia (Figure 1). ECG taken during the short periods of sinus rhythm attained with intravenous lignocaine infusions showed subtle depolarization abnormalities at the J point in the inferolateral leads that were accentuated by amiodarone (Figure 2).
The boy was normothermic at admission and required multiple attempts at cardioversion, along with intravenous amiodarone and magnesium and dual-chamber pacing to control the electrical storm. Because of the evidence of severe anoxic damage sustained during the initial cardiac arrest, mechanical cardiopulmonary support was not initiated. A limited autopsy confirmed normal coronary artery anatomy and caliber, a structurally normal heart, and evidence for myocardial necrosis consistent with prolonged hypoxia and catecholamine use. Polymer-ase chain reaction studies ruled out myocarditis of viral origin.
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.