Successful Suppression of Short-Coupled Purkinje VF Triggers With Flecainide
Document Type
Conference Proceeding
Publication Date
5-2024
Publication Title
Heart Rhythm
Abstract
Background: Idiopathic ventricular fibrillation accounts for 5-10 % of sudden cardiac arrest survivors. It usually affects young healthy individuals and diagnosis requires workup to exclude structural or molecular etiologies. Objective: To describe the role of Flecainide in suppressing short-coupled triggers of idiopathic VF Methods: A 28-year-old female patient with no significant past medical history presents following a witnessed sudden cardiac arrest. The patient was at her workplace when she collapsed and was found to be in VF. She was successfully defibrillated with 200 joules of unsynchronized shock. 12 lead EKG showed normal sinus rhythm, PR, QRS, and QT intervals and lacked any specific pattern of channelopathy. CTA was negative for PE and emergent coronary angiography revealed normal coronaries excluding an ischemic etiology of VF. 2D Echo was normal. Cardiac MRI revealed no evidence for late gadolinium enhancement, and normal cardiac size and function. Thus, no clear structural etiology was found. Gene panel testing is pending. Results: Telemetry showed frequent uniform short-coupled PVCs (sc-PVCs). The patient was started on IV Amiodarone and Esmolol, however, sc-PVCs persisted, triggering episodes of VF. She received 6 shocks with immediate defibrillation. Amiodarone was discontinued. The patient was loaded with Flecainide 300 mg, followed by Flecainide 100 mg twice daily. The patient’s scPVCs became infrequent and no longer triggered VF. Flecainide was increased to 100 mg every 8 hours with complete suppression of sc-PVCs. A subcutaneous ICD was placed, serial 50 Hz inductions failed to induce VF. Conclusion: All idiopathic VF patients require ICD placement due to its frequent and unpredictable recurrence. Pharmacological suppression of idiopathic VF triggers, i.e., scPVCs, are of paramount importance during the initial presentation. Catheter ablation of sc-PVCs triggering VF is effective but often performed in subsequent presentations due to ICD shocks or during the initial presentation if pharmacological suppression fails. We present a unique case of successfully suppressing idiopathic VF triggers with Flecainide during the index presentation.
Volume
21
Issue
5S
First Page
S306
Last Page
S307
Recommended Citation
Ahmad E, Tawney A, Mehta N, Kutinsky IB. Successful suppression of short-coupled purkinje VF triggers with flecainide. Heart Rhythm. 2024 May;21(5S):S306-S307. doi:10.1016/j.hrthm.2024.03.886
DOI
10.1016/j.hrthm.2024.03.886
Comments
Heart Rhythm Society Annual Meeting, May 16-19, 2024, Boston, MA