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Patient
61-year-old man with risk factors (active smoking and dyslipidemia) admitted to the intensive care unit for an acute anterior coronary syndrome; angioplasty was performed with stent placement in the anterior interventricular coronary artery 12 hours after the onset of symptoms; severely diminished left ventricular ejection fraction (30%); 10 days after this episode, new hospitalization for a recovered sudden death;
Trace
Identical morphology of the ventricular extrasystole; extrasystole triggering a burst of nonsustained polymorphic ventricular tachycardia;
Trace
Ventricular extrasystole with a slightly different morphology; retrograde atrial conduction and compensatory pause after the extrasystole; second ventricular extrasystole inducing an episode of ventricular fibrillation (wide QRS tachycardia, irregular, polymorphous, disorganized, tall oscillations with loss of alternation between systoles and diastoles); sudden onset of the arrhythmia after a ventricular extrasystole and a short cycle-long cycle-short cycle sequence; an electric shock was necessary to restore sinus rhythm;
Exergue
In the aftermath of myocardial scar, the survival of Purkinje fibers under anaerobic conditions may contribute to the occurrence of ventricular fibrillation and sudden death.
The causes of sudden death in the aftermath of a myocardial infarction are multifactorial and vary according to the delay relative to the onset of symptoms. An ischemia-induced ventricular fibrillation is responsible for most deaths occurring during the pre-hospital phase.