Syncopal ventricular tachycardia complicating paroxysmal atrial fibrillation in severe myocardial ischemia
Haïat, R.; Leroy, G.; Guyon, P.; Henry, I.; Halphen, C.; Stoltz, J.P.
Archives des Maladies du Coeur et des Vaisseaux 88(12): 1905-1910
1995
ISSN/ISBN: 0003-9683 PMID: 8729374 Document Number: 448355
The authors report two cases of spontaneous paroxysmal atrial fibrillation closely followed by syncopal ventricular tachycardia resulting in cardiac arrest requiring defibrillation. Both patients, men aged 62 and 64 years, had a past history of myocardial infarction without arrhythmias; atrial fibrillation occurred during severe myocardial ischaemia; coronary arteriography showed tight stenoses of the left main coronary artery with normal left ventricular function. Ventricular tachycardia (or fibrillation) during spontaneous paroxysmal atrial fibrillation is a rare occurrence. This sequence of events has been described in patients with accessory conduction pathways or in hypertrophic cardiomyopathy. It is an exceptionally rare complication of ischemic heart disease with only a very few previously reported cases. Myocardial ischaemia is probably the cause of the arrhythmia in together with irregularity of the ventricular contractions responsible for long cycle-short cycle sequences which are particularly arrhythmogenic and changes in sympathetic tone.