A rare phenomenon involving ventricular separation: a case report

Background: Ventricular separation is a multipart, extensive disease of the heart that hinders the electrical conduction of the cardiac system ventricular muscle, causing a bidirectional conduction block. The occurrence of ventricular separation suggests that the myocardium is in a state of severe ischemia, and the prognosis is generally poor. Herein, we present arescue case in which the extremely rare phenomenon of ventricular separation developed and was documented in realtime.

Case presentation: An 82-year-old man with syncope presented to the emergency departmentin a critical condition with no vital signs and was immediately treated via endotracheal intubation, mechanical ventilation, and cardiopulmonary resuscitation.The patient's electrocardiogram (ECG) showed two completely independent waveforms that were excited at their respective frequencies without interfering with one another, with the overall ECG resembling a third-degree atrioventricular block. A review of a previous ECG showed findings mimicking a first-degree atrioventricular block.Based on the patient's clinical manifestations, the ECG diagnoses were sinus arrest, ventricular escape rhythm, and ventricular separation. The patient was declared dead 30 min after rescue attempts failed.The ECG was variable in this case, and the original conduction-related ventricular wave showed complete separation that could easily have been misdiagnosed as an atrioventricular block. Since the patient was in a critical condition and his vital signs had disappeared, the ECG diagnoses supported ventricular separation.

Conclusions: Ventricular separation is not a static condition, and as observed in this case, it can manifest a number of dynamic changes. Therefore, it is imperative to study this uncommon phenomenon in order to gain an improved understanding of the electrocardiac system.