Abstract
Clinical manifestation of late onset recurrent monomorphic ventricular tachycardia (VT) in patients with normal left ventricular ejection fraction may elude diagnosis despite elaborate testing. This report describes a 67-year-old woman with structurally normal heart who presented with recurrent VT in the absence of predisposing factors. Repeated extensive diagnostic testing, including magnetic resonance imaging and coronary angiography, did not disclose any abnormality. An implantable cardioverter-defibrillator was placed following noninducibility of the third episode of VT at electrophysiological study. Patient's 12-lead electrocardiogram in normal sinus rhythm revealed permanent QRS fragmentation as well as T-wave inversions as the only warning features that heralded the impending appearance of recurrent VTs over the course of 5 years follow-up.
References
- 1 AHA/ACC/HRS statement on noninvasive risk stratification techniques for identifying patients at risk for sudden cardiac death. Circulation 118(14), 1497–1518 (2008).
- 2 . Significance of a fragmented QRS complex versus a Q-wave in patients with coronary artery disease. Circulation 113(21), 2495–2501 (2006).
- 3 Fragmented QRS on twelve-lead electrocardio-gram predicts arrhythmic events in patients with ischemic and nonischemic cardiomyopathy. Heart Rhythm 7(1), 74–80 (2010).
- 4 Fragmented QRS on surface electrocardiogram is not a reliable predictor of myocardial scar, angiographic coronary disease or long term adverse outcomes. Cardiovasc. Diagn. Ther. 4(4), 279–286 (2014).
- 5 Prevalence and prognostic significance of fragmented QRS complex in middle-aged subjects with and without clinical or electrocardiographic evidence of cardiac disease. Am. J. Cardiol. 114(1), 141–147 (2014).
- 6 Prevalence and prognostic significance of T-wave inversions in right precordial leads of a 12-lead electrocardiogram in the middle-aged subjects. Circulation 125(21), 2572–2577 (2012).
- 7 . Fragmented QRS for the prediction of sudden cardiac death: a meta-analysis. Europace 17(6), 969–977 (2015).
- 8 Risk stratification in Brugada syndrome: results of the PRELUDE (PRogrammed ELectrical stimUlation preDictive valuE) registry. J. Am. Coll. Cardiol. 59(1), 37–45 (2012).
- 9 . QRS fragmentation in standard ECG as a diagnostic marker of arrhythmogenic right ventricular dysplasia-cardiomyopathy. Heart Rhythm 5(10), 1417–1421 (2008).
- 10 . Recent advances in the diagnosis and management of cardiac amyloidosis. Future Cardiol. 10(1), 131–146 (2014).
