Transesophageal Cardioversion and Defibrillation

Ventricular fibrillation induced by transesophageal atrial pacing in hypertrophic cardiomyopathy.

Favale S, Di Biase M, Rizzo U, Minafra F, Rizzon P. University of Bari, Italy. Eur Heart J 1987 Aug;8(8):912-6. Sudden death is a rather frequent occurrence in patients with hypertrophic cardiomyopathy, yet the mechanism is uncertain in most cases. We describe a case of an 18 years old patient with a family history of hypertrophic cardiomyopathy and sudden death in whom ventricular fibrillation could be repeatedly induced by means of transesophageal atrial stimulation with 1:1 AV conduction at a rate of 200 beats min-1 and prevented by pharmacological depression of AV node. The not particularly high ventricular rate at which VF occurred could suggest that in hypertrophic cardiomyopathy a major role in favouring VF induction is played by the electrophysiological properties of the myocardium and that sudden death can occur as a consequence of different atrial tachyarrhythmias.

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