1. Case report: electrical storm during induced hypothermia in a patient with early repolarization.
- Author
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Badertscher, Patrick, Kuehne, Michael, Schaer, Beat, Sticherling, Christian, Osswald, Stefan, and Reichlin, Tobias
- Subjects
THUNDERSTORMS ,HYPOTHERMIA ,BODY temperature ,ELECTROCARDIOGRAPHY ,HEART beat ,HEART conduction system ,ADRENERGIC beta agonists ,ISOPROTERENOL ,ARRHYTHMIA ,CARDIAC arrest ,INDUCED hypothermia ,MAGNETIC resonance imaging ,VENTRICULAR fibrillation ,THERAPEUTICS - Abstract
Background: Population based studies showed an association of early repolarization in the electrocardiogram (ECG) and a higher rate of sudden cardiac death presumably due to ventricular fibrillation. The triggers for ventricular fibrillation in patients with early repolarization are not fully understood.Case Presentation: We describe the case of a young patient with a survived ventricular fibrillation arrest while asleep followed by multiple episodes of recurrent ventricular fibrillation. The admission ECG showed an early repolarization pattern with substantial J-point elevation in most of the ECG-leads. After initiation of a hypothermia protocol, the patient developed an electrical storm with multiple ventricular fibrillation episodes requiring multiple cardioversions. Intravenous isoproterenol infusion successfully suppressed the malignant arrhythmia.Conclusion: Hypothermia appears proarrhythmic in patients with early repolarization and may trigger ventricular fibrillation. This knowledge is particularly important when initiating temperature management protocols in patients after a survived cardiac arrest. During the acute phase of an early repolarization associated electrical storm, isoproterenol is the most effective treatment suppressing the ventricular fibrillation-inducing premature ventricular complexes at higher heart rates. [ABSTRACT FROM AUTHOR]- Published
- 2017
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