PMC3566980_01
TDP with fast degeneration into Ventricular Fibrillation. The ECG-strip pre-TDP (Figure1A) shows a QT interval of 640 msec (QTc is 542 msec).
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F1
Few hours after the admission at the Emergency Room (ER) the patient experienced a cardiac arrest due to a "Torsade de Pointes" (TdP) degenerated into ventricular fibrillation which required DC shock (200 J), as documented by electrocardiogram (ECG) (Figure 1).
ECG at the admission to ICU shows a LBBB with a prolonged QT/QTc interval (640-542 msec).
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F2
On admission to the cardiology Intensive Care Unit (ICU) the ECG disclosed sinus bradycardia (55 bpm) with significant alteration in the QT interval (QT/QTc = 640/543 msec; Figure 2) that was significantly prolonged over a 24-hour period.
Coronary Angiography. No significant CAD is detected in right cororary artery. The middle left anterior descending coronary artery had a non-significant stenosis (< 50%), as confirmed by IVUS control.
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F3
The middle left anterior descending coronary artery (LAD) had a non-significant stenosis (< 50%) as revealed by coronary angiography and IVUS control (Figure 3). A not significant stenosis was detected in a non-dominant right coronary artery (Figure 3).
ECG at hospital discharge. QT interval measures 400 msec, the QTc interval 430 msec.
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F4
The patient was discharged 7 days after admission, following the placement of an implantable cardioverter-defibrillator (ICD); the ECG at discharge showed a LBBB with a normal QT interval (QT/QTc = 400/430 msec; Figure 4).
ECG at 1-year follow-up shows stable LBBB and normal QT/QTc interval (405/432 msec).
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F5
After 12 and 24 months of follow-up She has been clinically stable, no shock detected at ICD registration and her QT interval was normal (Figure 5).