Iatrogenic ventricular fibrillation caused by inappropriately synchronized cardioversion in a patient with pre-excited atrial fibrillation: A case report. Issue 1 (January 2021)

• Record Type: Journal Article
• Authors: Ikeda, Syuhei; An, Yoshimori; Yanagisawa, Masami; Ishigami, Kenjiro; Aono, Yuya; Doi, Kosuke; Ishii, Mitsuru; Iguchi, Moritake; Ogawa, Hisashi; Masunaga, Nobutoyo; Abe, Mitsuru; Akao, Masaharu
• Is Part Of: Journal of cardiology cases. Volume 23:Issue 1(2021)
• Page Start: 31
• Page End: 34
• Publication Date: 2021-01
• Subjects: Pre-excited atrial fibrillation -- Cardioversion -- Iatrogenic ventricular fibrillation -- Wolff–Parkinson–White syndrome; Cardiology -- Periodicals; Cardiovascular Diseases -- Case Reports; Cardiovascular Diseases -- Periodicals; Cardiology -- Case Reports; Cardiology -- Periodicals; Cardiology; Electronic journals; Periodicals; 616.12
• DOI: 10.1016/j.jccase.2020.08.014
• Languages: English
• ISSNs: 1878-5409

Abstract

Abstract: Direct-current (DC) cardioversion is effective at terminating arrhythmias in an emergency. During treatment, energy delivery synchronizing with the QRS complex is essential to avoid ventricular fibrillation (VF) caused by a shock on the T wave, which is the vulnerable period of ventricular repolarization. However, distinguishing the QRS from the T wave is difficult in some patients with abnormal, irregular, and varying QRS complexes. We report the case of a 45-year-old man who had iatrogenic VF caused by inappropriate synchronization with the T wave during cardioversion of pre-excited atrial fibrillation due to high ventricular rates and varying R wave amplitude affected by an accessory pathway. <Learning objective: During direct-current cardioversion, energy delivery synchronizing with the QRS complex is essential to avoid ventricular fibrillation (VF) caused by a shock on the T wave. However, distinguishing the QRS from the T wave is difficult in some patients with abnormal, irregular, and varying QRS complexes. We report a case of iatrogenic VF caused by failed synchronization with the R wave in a patient with pre-excited atrial fibrillation (AF). Clinicians managing pre-excited AF should be aware of the possibility of iatrogenic VF triggered by cardioversion.>