PMC9189425_01
(A) EKG during hemodialysis prior to ventricular tachycardia initiation. Rapid ventricular response atrial fibrillation with new-onset V4-V6 ST-segment depression and aVR ST-segment elevation. (B) Intracardiac electrograms (EGMs) showing induction of VF-zone monomorphic ventricular tachycardia (constant cycle lengths and EGMs with new-onset morphology) after intradialytic onset of paroxysmal rapid ventricular response atrial fibrillation (irregularly irregular cycle lengths). VF, ventricular fibrillation.
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F1
ST-depression, and aVR ST-segment elevation (Figure 1A). Sinus rhythm with frequent monomorphic premature ventricular complexes (PVCs) consistent with inferior-wall origin morphology was evident upon admission. AF (mean CL 360 ms) led to monomorphic fast VT induction (CL 220 ms), which degenerated into VF. All episodes of VT were preceded by AF (Figure 1B).
Contrast enhanced cardiovascular magnetic resonance imaging. Cine images diastolic frames in short axis at the base (top left) and at the level of papillary muscle (top right) showing asymmetrical left ventricular hypertrophy. Late Gadolinium enhancement phase sensitive inversion recovery (PSIR) imaging in short axis (Base left) and 2-chambers view (Base right), respectively, showing the subendocardial scar at the base of the inferior wall (red arrow). The transmurality of the scar was reported at 50-75%, however, note that only one segment is infarcted, while the rest of the territory supplied by the right coronary artery is viable.
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Additionally, cardiac MRI (Figure 2) demonstrated LV dilation (160 ml/sqm) with mild systolic dysfunction (LVEF 41%).