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Iatrogenic ventricular fibrillation caused by inappropriately synchronized cardioversion in a patient with pre-excited atrial fibrillation: A case report. 2021

Syuhei Ikeda, and Yoshimori An, and Masami Yanagisawa, and Kenjiro Ishigami, and Yuya Aono, and Kosuke Doi, and Mitsuru Ishii, and Moritake Iguchi, and Hisashi Ogawa, and Nobutoyo Masunaga, and Mitsuru Abe, and Masaharu Akao
Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.

Direct-current (DC) cardioversion is effective at terminating arrhythmias in an emergency. During treatment, energy delivery synchronizing with the QRS complex is essential to avoid ventricular fibrillation (VF) caused by a shock on the T wave, which is the vulnerable period of ventricular repolarization. However, distinguishing the QRS from the T wave is difficult in some patients with abnormal, irregular, and varying QRS complexes. We report the case of a 45-year-old man who had iatrogenic VF caused by inappropriate synchronization with the T wave during cardioversion of pre-excited atrial fibrillation due to high ventricular rates and varying R wave amplitude affected by an accessory pathway. <Learning objective: During direct-current cardioversion, energy delivery synchronizing with the QRS complex is essential to avoid ventricular fibrillation (VF) caused by a shock on the T wave. However, distinguishing the QRS from the T wave is difficult in some patients with abnormal, irregular, and varying QRS complexes. We report a case of iatrogenic VF caused by failed synchronization with the R wave in a patient with pre-excited atrial fibrillation (AF). Clinicians managing pre-excited AF should be aware of the possibility of iatrogenic VF triggered by cardioversion.>.

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