PMC2705722_01
(a) ECG recorded 48 h before electrical storm showed early repolarization in V2-V6 leads. (b) Occurrence of premature ventricular contraction and ventricular fibrillation. (c) Resting ECG between two ventricular fibrillations displayed major J point and ST elevation in V2-V6 leads
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Fig1
She had been examined three days earlier by her general practitioner who had found no cardiac or neurological abnormalities, and the resting ECG displayed early repolarization pattern extended in all the precordial leads (particularly in V2) as well as inferior leads, together with positive T waves (Fig. 1(a)). In the emergency room, new syncopes occurred, and ECG monitoring revealed numerous ventricular ectopic beats followed by ventricular fibrillation (VF) (Fig. 1(b)). Intercritical electrocardiogram showed now sinus rhythm with early repolarization characterized by 4 mm prominent J wave and following down sloping ST elevation with negative T waves, in most of the precordial leads as well in the inferior leads to a lesser extend (Fig. 1(c)). ECG (Fig. 1(a)) and the ECG performed just before VF, which resembled the Osborn wave (Fig. 1(c)). Early repolarization affects about 1-5 % of the general population and is defined by the elevation of the J wave at least 1 mm above the baseline.
(a) and (b) Onset of two ventricular arrhythmias. The sequence is always the same: a premature beat with major early repolarization (*) and long coupling interval (450 ms) was followed by a premature ventricular beat ( ) left bundle branch block pattern and left axis with short coupling interval (320 ms) initiating VF. Episodes of VF was closely linked to the J point elevation
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Fig2
Several VF episodes occurred which always started with the same sequence: a premature beat with major early repolarization was followed by a premature ventricular beat (left bundle branch block pattern and left axis with short coupling interval 320 ms) initiating VF (Fig. 2(a,b).
Electrocardiographic patterns before and during isoproterenol infusion. Before isoproterenol J point and ST elevations were observed in leads V2-V6. During isoproterenol J point and ST segment were isoelectrical while heart rate was 110 / min
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Fig3
Half an hour after starting isoproterenol infusion, sinus rhythm was about 110-120 beats / min, the VF episodes disappeared, and the repolarization tended to be normalized (Fig. 3).