© 2000 by European Society of Cardiology
ELECTROPHYSIOLOGY
Ventricular fibrillation induced by rapid atrial rates in patients with hypertrophic cardiomyopathy
1Cardiology Service, Hospital Universitario 12 de Octubre Madrid, Spain; 2Cardiology Service, Hospital Universitario de Getafe Madrid, Spain
Abstract
AIMS: To describe the mechanisms of induction of ventricular fibrillation (VF) by rapid atrial rates in patients with hypertrophic cardiomyopathy (HCM).
METHODS: Electrophysiological studies, management and follow-up in three patients with HCM with VF induced by atrial pacing.
RESULTS: In one patient, spontaneous sinus tachycardia triggered VF. In another patient, VF occurred after verapamil infusion during rapid atrial fibrillation, and in the remaining patient there was no clinical VF. In all three patients, short runs of atrial pacing (cycle length 272–380 ms) induced VF, and QRS widening preceded fibrillation in all patients. Marked ventricular electrogram fragmentation was documented in one patient during atrial pacing and in another patient during late ventricular extrastimuli. Hypotension was associated with sinus tachycardia in one patient. The two patients developing clinical VF underwent atrioventricular (AV) junctional ablation; a ventricular defibrillator was implanted in one, and a mode-switching dual-chamber pacemaker in the other. No arrhythmic events occurred during 34- and 35-month follow-up, respectively. In the other patient, postatrial fibrillation pauses caused syncope, and he is asymptomatic 52 months after implantation of a dual-chamber pacemaker.
CONCLUSIONS: Rapid atrial rates can trigger VF in some patients with HCM, probably through a combination of electrophysiological and ischaemic mechanisms. AV junctional ablation may prevent VF in selected cases.
Key Words: Hypertrophic cardiomyopathy, ventricular fibrillation, sudden death, syncope, atrioventricular junctional ablation
Correspondence: Dr M. López Gil, Servicio de Cardiología, Hospital ‘12 de Octubre’, Carretera de Andalucía, km 5,4, 28041 Madrid, Spain.
References
[1] Maron BJ and Fananapazir L. Sudden cardiac death in hypertrophic cardiomyopathy. Circulation 1992; 85:(Suppl I) 57–63.
[2] Fananapazir L, Tracy CM, Leon ML, et al. Electrophysiologic abnormalities in hypertrophic cardiomyopathy: a consecutive analysis in 155 patients. Circulation 1989; 80: 1259–1268.
[3] Frenneaux MP, Counihan PJ, Caforio ALP, Chikamori T, McKenna WJ. Abnormal blood pressure response during exercise in hypertrophic cardiomyopathy. Circulation 1990; 82: 1995–2002.
[4] Fananapazir L and Epstein SE. Hemodynamic and electrophysiologic evaluation of patients with hypertrophic cardiomyopathy surviving cardiac arrest. Am J Cardiol 1991; 67: 280–287.[CrossRef][Web of Science][Medline]
[5] Kuck K-H, Kunze KP, Schluter M, Nienaber CA, Costard A. Programmed electrical stimulation in hypertrophic cardiomyopathy. Results in patients with and without cardiac arrest or syncope. Eur Heart J 1988; 9: 177–185.
[6] Watson RM, Schartz JL, Maron BJ, Tucker E, Rosing DR, Josephson ME. Inducible polymorphic ventricular tachycardia and ventricular fibrillation in a subgroup of patients with hypertrophic cardiomyopathy at high risk for sudden death. J Am Coll Cardiol 1987; 10: 761–774.[Abstract]
[7] Saumarez RC, Camm AJ, Panagos A, et al. Ventricular fibrillation in hypertrophic cardiomyopathy is associated with increased fractionation of paced right ventricular electrograms. Circulation 1992; 86: 467–474.
[8] Stafford WJ, Trhoman RG, Bilsker M, Zaman L, Castellanos A, Myerburg RJ. Cardiac arrest in an adolescent with atrial fibrillation and hypertrophic cardiomyopathy. J Am Coll Cardiol 1986; 7: 701–704.[Abstract]
[9] Favale S, Di Biase M, Rizzo U, Minafra F, Rizzon P. Ventricular fibrillation induced by transesophageal atrial pacing in hypertrophic cardiomyopathy. Eur Heart J 1987; 8: 912–916.
[10] Madariaga I, Carmona JR, Mateas FR, Lezaun R, de los Arcos E. Supraventricular arrhythmia as the cause of sudden death in hypertrophic cardiomyopathy. Eur Heart J 1994; 15: 134–137.
[11] Klein G, Bashore TM, Sellers TD, Pritchett EL, Smith WM, Gallagher JJ. Ventricular fibrillation in the Wolff-Parkinson-White syndrome. N Engl J Med 1979; 301: 1080–1085.[Abstract]
[12] Brembilla-Perrot B, Terrier de la Chaise A, Beurrier D. La fibrillation auriculaire paroxystique: principale cause de syncope dans la cardiomyopathie hypertrophique? Arch Mal Coeur Vaiss 1993; 86: 1573–1578.[Web of Science][Medline]
[13] Schiavone VA, Maloney JD, Lever HM, Castle LW, Sterba R, Morant V. Electrophysiologic studies of patients with hypertrophic cardiomyopathy presenting with syncope of undetermined etiology. Pacing Clin Electrophysiol 1986; 9: 476–481.[CrossRef][Medline]
[14] Brembilla-Perrot B, Beurrier D, de la Chaise AT, et al. Significance and prevalence of inducible atrial tachyarrhythmias in patients undergoing electrophysiologic studies for presyncope or syncope. Int J Cardiol 1996; 53: 61–69.[CrossRef][Web of Science][Medline]
[15] Cosio FG, Moro C, Sáenz de la Calzada C, Llovet A. The Q waves of hypertrophic cardiomyopathy. An electrophysiologic study. N Engl J Med 1980; 302: 96–99.[Web of Science][Medline]
[16] Saumarez RC, Slade AK, Grace AA, Sadoul N, Camm AJ, McKenna WJ. The significance of paced electrogram fractionation in hypertrophic cardiomyopathy: A prospective study. Circulation 1995; 91: 2762–2768.
[17] Wellens H, Brugada P, Stevenson WG. Programmed electrical stimulation of the heart in patients with life threatening arrhythmias: what is the significance of induced arrhythmias and what is the correct stimulation protocol? Circulation 1985; 72: 1–7.
[18] Fananapazir L, Chang AC, Epstein SE, McAreavey D. Prognostic determinants in hypertrophic cardiomyopathy. Prospective evaluation of a therapeutic strategy based on clinical, holter, hemodynamic and electrophysiological findings. Circulation 1992; 86: 730–740.
[19] Sadoul N, Prasad K, Elliott PM, Bannarjee S, Frenneaux MP, McKenna WJ. Prospective prognostic assessment of blood pressure response during exercise in patients with hypertrophic cardiomyopathy. Circulation 1997; 96: 2987–2991.
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