Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Case Study
  • Published:

A case of vagally mediated idiopathic ventricular fibrillation

Nature Clinical Practice Cardiovascular Medicine volume 5, pages 111–115 (2008)Cite this article

Abstract

Background A 25-year-old woman experienced three episodes of syncope over the course of 2 years. The attacks all occurred just after she had sat down, and two were accompanied by convulsions. She had no obvious prodromes and no personal or family history of cardiovascular disease.

Investigations Electrocardiography, chest radiography, echocardiography, cerebral and cardiac MRI, electroencephalography, 24 h Holter monitoring, electrophysiological study with drug provocation testing and heart-rate variability analysis.

Diagnosis Vagally mediated ventricular fibrillation initiated by premature ventricular complexes arising from the right ventricular outflow tract.

Management Catheter ablation was performed at the right ventricular outflow tract and an implantable cardioverter-defibrillator was fitted.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: 24 h Holter monitoring recorded a total of 107 premature ventricular complexes, which occurred mostly when the patient was asleep (as indicated by the decrease in average heart rate).
Figure 2: Repeated 12-lead electrocardiography demonstrated bigeminal premature ventricular complexes (PVCs) with a left bundle branch block QRS pattern and tall R waves in the inferior leads.
Figure 3: Upon cessation of the tilt-table test, electrocardiography recorded single, couplet and triplet premature ventricular complexes followed by an 8-beat run of nonsustained polymorphic ventricular tachycardia.
Figure 4: Intravenous administration of 10 mg edrophonium chloride provoked premature ventricular complexes, as recorded on electrocardiography.
Figure 5: After an attempt to take a blood sample from the patient's arm, electrocardiography demonstrated a slowing of the sinus rhythm followed by a single premature ventricular complex which led to polymorphic ventricular tachycardia.

References

  1. Mathias CJ et al. (2001) Observations on recurrent syncope and presyncope in 641 patients. Lancet 357: 348–353

    Article  CAS  Google Scholar 

  2. Kennedy HL et al. (1985) Long-term follow-up of asymptomatic healthy subjects with frequent and complex ventricular ectopy. N Engl J Med 312: 193–197

    Article  CAS  Google Scholar 

  3. Leenhardt A et al. (1994) Short-coupled variant of torsade de pointes: a new electrocardiographic entity in the spectrum of idiopathic ventricular tachyarrhythmias. Circulation 89: 206–215

    Article  CAS  Google Scholar 

  4. Zipes DP et al. (2006) ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114: e385–484

    Article  Google Scholar 

  5. Viskin S et al. (2005) The “short-coupled” variant of right ventricular outflow ventricular tachycardia: a not-so-benign form of benign ventricular tachycardia. J Cardiovasc Electrophysiol 16: 912–916

    Article  Google Scholar 

  6. Lerman BB et al. (1995) Mechanism of repetitive monomorphic ventricular tachycardia. Circulation 92: 421–429

    Article  CAS  Google Scholar 

  7. Noda T et al. (2005) Malignant entity of idiopathic ventricular fibrillation and polymorphic ventricular tachycardia initiated by premature extrasystoles originating from the right ventricular outflow tract. J Am Coll Cardiol 46: 1288–1294

    Article  Google Scholar 

  8. Takatsuki S et al. (2001) Catheter ablation of a monofocal premature ventricular complex triggering idiopathic ventricular fibrillation. Heart 86: e3

    Article  CAS  Google Scholar 

  9. Haissaguerre M et al. (2002) Mapping and ablation of idiopathic ventricular fibrillation. Circulation 106: 962–967

    Article  Google Scholar 

  10. Hachiya H et al. (2005) Edrophonium-induced right ventricular outflow tract tachycardia. Pacing Clin Electrophysiol 28 (Suppl): S158–S162

    Article  Google Scholar 

  11. Bloch Thomsen PE et al. (2005) Phase 2 reentry in man. Heart Rhythm 2: 797–803

    Article  Google Scholar 

  12. Litovsky SH and Antzelevitch C (1990) Differences in the electrophysiological response of canine ventricular subendocardium and subepicardium to acetylcholine and isoproterenol: a direct effect of acetylcholine in ventricular myocardium. Circ Res 67: 615–627

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors would like to thank K Fukumoto for his cooperation in collecting data, and J Annis for his linguistic advice.

Author information

Authors and Affiliations

  1. K Tanimoto is a Cardiology Assistant and S Ogawa is a Professor and Chairman of the Cardiology Division, Department of Internal Medicine, M Akaishi is Associate Professor at the Kitasato Institute and Director of Cardiology in the Department of Medicine, M Kataoka is a Fellow in Cardiology, S Takatsuki is an Associate Professor, Keio University School of Medicine, Kitasato Institute Hospital, and H Mitamura is Deputy Director of Saisekai Central Hospital, Tokyo, Japan.,

    Masaharu Kataoka, Seiji Takatsuki, Kojiro Tanimoto, Makoto Akaishi, Satoshi Ogawa & Hideo Mitamura

Authors
  1. Masaharu Kataoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seiji Takatsuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kojiro Tanimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Makoto Akaishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Satoshi Ogawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hideo Mitamura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seiji Takatsuki.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kataoka, M., Takatsuki, S., Tanimoto, K. et al. A case of vagally mediated idiopathic ventricular fibrillation. Nat Rev Cardiol 5, 111–115 (2008). https://doi.org/10.1038/ncpcardio1082

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpcardio1082

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing