The short-long-short-short sequence and polymorphic ventricular tachycardias storm

Ann Noninvasive Electrocardiol. 2023 May;28(3):e13034. doi: 10.1111/anec.13034. Epub 2022 Dec 13.

Abstract

We described a case of a patient who developed repetitive episodes of polymorphic ventricular tachycardias with a stereotypical pattern of initiation. A short-long-short-short (S-L-S-S) cardiac cycle sequence preceded all episodes and was considered to be the underlying initiative mechanism for these fatal arrhythmic events. In the patient, the paroxysmal atrial fibrillation was responsible for S-L-S-S sequence. It had been suggested that the electrophysiological mechanism by which the S-L-S-S cardiac sequence induces ventricular tachyarrhythmias was reentrant excitation, not early afterdepolarization and triggered activity. Early attempts to restore and maintain sinus rhythm by administration of antiarrhythmic drug with amiodarone, the patient experienced no atrial fibrillation and ventricular tachycardia recurrence.

Keywords: atrial fibrillation; electrical storm; reentry early afterdepolarization ventricular tachycardias.

Publication types

  • Case Reports

MeSH terms

  • Amiodarone* / therapeutic use
  • Anti-Arrhythmia Agents / therapeutic use
  • Atrial Fibrillation* / complications
  • Atrial Fibrillation* / drug therapy
  • Electrocardiography
  • Humans
  • Tachycardia, Ventricular* / diagnosis
  • Tachycardia, Ventricular* / drug therapy

Substances

  • Anti-Arrhythmia Agents
  • Amiodarone