Short-coupling premature ventricular complexes from the left ventricle triggered isoproterenol-resistant electrical storm in a patient with Brugada syndrome.

摘要

Introduction: Multiple episodes of polymorphic ventricular tachycardia (PVT), triggered by short-coupling (280-300 ms) premature ventricular complexes (PVCs) showing a right bundle branch block (RBBB) pattern, occurred in a patient with Brugada syndrome. Isoproterenol infusion attenuated ST-segment elevation in leads V_2-V_3, but the triggered PVCs and PVT itself were not inhibited but rather increased. An implantable cardioverter-defibrillator (ICD) was introduced with a supplemental treatment of bepridil (150 mg/d), which minimized his ST-segment elevation. During a follow-up period of 10 months, neither PVT nor syncope episode recurred. Even though rare, PVT can be triggered by short-coupled PVCs from the left ventricle owing to a mechanism other than phase 2 reentry, and the therapeutic effects of isoproterenol may be limited in some patients with Brugada syndrome.