Polymorphic ventricular tachycardia induced by Valsalva manoeuvre in a patient with paroxysmal supraventricular tachycardia.

摘要

A 54-year-old man was admitted for an episode of palpitations. He was previously in good health, took no regular medications, and had no major risk factors for ischaemic heart disease. He reported several episodes of self-terminating palpitations in the past years. Haemoglobin, thyroid-stimulating hormone, and electrolytes serum levels were within the normal range. A 12-lead electrocardiogram showed a narrow QRS-complex tachycardia at a rate of 210 b.p.m.; P-waves inscribed at the end of every QRS complex were detectable in D2 and aVF limb leads.The patient was then instructed to perform Valsalva manoeuvre, during which a short burst of non-sustained, self-terminating polymorphic ventricular tachycardia was recorded (Figure 1) before cardioversion to stable sinus rhythm occurred. The ventricular arrhythmia onset was not preceded by significant bradycardia or pause. A repeated 12-lead electrocardiogram showed sinus rhythm without conduction system disease and with a normal QT interval.