Syncope and ventricular tachycardia
Tracing
Manufacturer Medtronic
Device ILR
Field Reveal DX / Reveal XT
N° 5
Patient
A 63-year-old man suffering from ischemic cardiomyopathy, old anterior myocardial infarction with a 48% left ventricular ejection fraction, non-specific bundle branch block and 120-ms QRS duration underwent negative electrophysiological studies and programmed ventricular stimulation after a sudden episode of syncope. A Reveal DX was implanted.
Graph and trace
This patient suffered 3 syncopal episodes within 2 days, one of which was complicated by trauma. He triggered a recording for the 3rd episode only, labeled “symptom” on the episodes log. The first 2 syncopal episodes coincided with both episodes diagnosed as VT. The analyzed episode, diagnosed as VT by the device, lasted over 1 minute, at a mean rate of 200 bpm.
- sinus rhythm;
- wide ventricular extrasystoles isolated or in triplets with ≥3 different morphologies;
- ventricular extrasystole with sudden onset of a wide complex regular tachycardia at 200 bpm;
- TD: detection of a VT episode by the device; the rate, sudden onset and stability criteria were fulfilled, prompting the diagnosis of VT, which is highly probable given the clinical presentation and the ECG characteristics of wide QRS and probable atrioventricular dissociation;
- spontaneous termination after over 1 minute of tachycardia.
Other articles that may be of interest to you
This was a Class 4D syncope (VT) in the ISSUE classification. The identification of a ventricular tachyarrhythmia in the wake of syncope is relatively rare after detailed investigations, including programmed ventricular pacing. A depressed left ventricular ejection fraction and the inducibility of a ventricular tachycardia are the 2 most reliable predictors of a ventricular arrhythmia causing syncope. Therefore, this patient’s presentation was relatively atypical. The confirmation of a ventricular arrhythmia causing syncope in this patient presenting with ischemic heart disease is a Class I indication for the implantation of an ICD. This clinical case highlights the high diagnostic value of this type of device, as well as its lack of therapeutic contribution. The diagnosis was made and the patient was appropriately treated after the spontaneous termination of a life-threatening tachyarrhythmia.