Question of the week


warm-up for EHRA2021 :

A 19-year old male was admitted after aborted sudden cardiac death, with ongoing mechanical ventilation and stable haemodynamic parameters without the need for inotropic or vasopressor agents. There was no relevant comorbidity in the history, the patient was a heavy smoker (5 pack-year) and used cannabinoids occasionally. Before the event the patient consumed an excessive amount of alcohol, he fainted suddenly while dancing. After 5 minutes of immediately started BLS, ALS was initiated by the Ambulance Service. Ventricular fibrillation was recorded, after repeated defibrillations, ROSC occurred after 20 minutes. During ALS 300 mg amiodarone and 4 mg epinephrine was administered. Resting ECG showed 80 BPM sinus rhythm with suspected pre-excitation.

What"s the most likely cause of aborted sudden cardiac arrest in this patient?

 

Answer:

Thank you Peter Perge et al. for this great case .

The patient had a normal coronary angiogram and normal cardiac MRI. During a period of further observation he developed a narrow complex tachycardia at 180 beats per minute. Further ECGs suggested evidence of pre-excitation more clearly and he underwent an EP study and successful ablation of a left posterolateral accessory pathway. An invasive EPS with ablation is recommended in WPW syndrome patients after aborted SCD due to an AF episode and rapid conduction over the AP, causing VF. During the EPS the anterograde and retrograde conduction properties of the AP should be recorded, alongside with the shortest RR interval during induced AF if it occurs during rapid atrial pacing.