BACKGROUND: Some types of ventricular tachycardia(VT), so called verapamil-sensitive ventricular tachycardia, occur in healthy young people without organic heart disease. The mechanism of the above VT is not established yet. The most possible mechanism is a triggered activity but reentry is also possible mechanism. We studied the possible mechanism and the eletrophysiologic properties of the verapamil-sensitive VT in 6 patients. METHODS: The patients included in this study were patients with documented ventricular tachycardia response to intravenous verapamil and complete RBBB morpholgy. As noninvasive tests, treadmill test, echocardiography and MUGA scan were performed and endomyocardial biopsy was perfomed in all patients in all patients and in patients with inducible VT, the electrophysiologic study was repeated on next day. The response to various antiarrhythmic agents was also studied. RESULTS: Total studied patients were 6(M : F=5 : 1, mean age=22). The noninvasive tests were normal in all patients and the VT was not induecd during treadmill test. The average cycle length of VT was 370msec and the 12-lead ECG during VT showed complete RBBB. The endomyocardial biopsy showed a mild focal infiltration of inflammatory cell in one patient and moderate small vessel vasculosclerosis in one patient. The clinical VT was induced in 5 patients by programmed electrical stimulation(PES). VT was induced in 5 by ventricular stimulation and in 1 by atrial stimulation. The induction and termination modes changed in 4 of 5 on next day. The cycle length dependency of PVC could be measured in 3 patients and the relationship was same direction in 2 patients and inverse direction in another patient. Intravenous procainamide was effective in 2 of 4 patients and IV adenosine was effective in 1 of 5 patients and IV propranolol was not effective in all 3 patients. CONCLUSION: The verapamil-sensitive ventricular tachycardia is a unique VT showing characteristics of both reentry and triggered activity but in one patient of our study, the most possible mechanism is triggered activity. A further cellular electrophysiologic study is needed for the genesis of verapamil-sensitive ventricular tachycardia.
Adenosine ; Biopsy ; Echocardiography ; Electrocardiography ; Exercise Test ; Heart Diseases ; Humans ; Procainamide ; Propranolol ; Tachycardia, Ventricular* ; Verapamil

Since Romano(1963) described Romano-Ward syndrome which is characterized by Q-T prolongation, abnormal T wave, ventricular tachcardia and syncopal attacks, about twenty cases have been reported in various countries of the world, but this case represents the first report of this syndrome in Korea. Authous experienced a case of Romano-Ward syndrome in a 23-year-old man who had been suffering from intermittent paroxysmal palpitation, chest discomfort and dyspnea for 11 years. On admission, he had tachycardia, gallop and engorgement of jugular veins. EKG showed ventricular tachycardia which promptly recurred after repeated attempts of cardioversion. Then, procainamide and digoxin were given. One day later, sinus bradycardia with Q-T prolongation with Deep T wave inversion occured. Therefore, propranol was prescribed under the impression of Romano-Ward syndrome. About 4 months later, EKG was normal except for mild Q-T prolongation and he was able to maintain normal life activity without difficulty.
Bradycardia ; Digoxin ; Dyspnea ; Electric Countershock ; Electrocardiography ; Humans ; Jugular Veins ; Korea ; Procainamide ; Romano-Ward Syndrome* ; Tachycardia ; Tachycardia, Ventricular ; Thorax ; Young Adult

An 82-year-old female, with left femoral neck fracture was scheduled for left hip hemiarthroplasty, under spinal anaesthesia. She had been suffering from diabetes, hypertension, lung cancer and was previously treated with IV aminophylline for respiratory insufficiency. She was given spinal anaesthesia with 10 mg of 0.5% hyperbaric bupivacaine, and T6 sensory block level was established. After 10 minutes, her blood pressure dropped to 80/60 mmHg, so intravenous ephedrine was given. At that moment, multifocal atrial tachycardia (MAT) appeared on electrocardiogram (ECG). Intravenous infusion of phenylephrine and procainamide was given and conversion of MAT to sinus rhythm was successfully achieved. We report a case of MAT after spinal anaesthesia, in a patient with respiratory insufficiency previously treated with IV aminophylline, which was successfully treated by intravenous infusion of phenylephrine and procainamide.
Aged, 80 and over ; Aminophylline ; Blood Pressure ; Bupivacaine ; Electrocardiography ; Ephedrine ; Female ; Femoral Neck Fractures ; Hemiarthroplasty ; Hip ; Humans ; Hypertension ; Infusions, Intravenous ; Lung Neoplasms ; Phenylephrine ; Procainamide ; Respiratory Insufficiency ; Stress, Psychological ; Tachycardia

In 1992, Brugada described clinical features of patients with aborted sudden cardiac death who showed no demonstrable heart disease and a peculiar ECG pattern consisting of right bundle branch block and ST-segment elevation in right precordial leads. Recently, We experienced two cases with aborted sudden cardiac death and similar ECG pattern. Physical examination, routine laboratory tests including serum electrolytes, echocardiography, myocardial thallium SPECT, MRI and MIBG scans were within normal limit. Arrhythmias were not induced in treadmill exercise test, and signal averaged ECGs revealed positive late potentials. Coronary angiography showed normal coronary artery with no evidence of induced vasospasm. Polymorphic ventricular tachycardia and ventricular fibrillation were induced by ventricular stimulation. Intravenous administration of flecainide, procainamide augmented ST segment elevation in one patient, and isoproterenol reduced ST segment elevation in the other patient. For prevention of sudden death, ICDs were implanted in the two patients. Ventricular fibrillations occurred in one patient 12 and 13 months after the implantation and were successfully terminated by ICD.
3-Iodobenzylguanidine ; Administration, Intravenous ; Arrhythmias, Cardiac ; Bundle-Branch Block* ; Coronary Angiography ; Coronary Vessels ; Death, Sudden ; Death, Sudden, Cardiac* ; Echocardiography ; Electrocardiography ; Electrolytes ; Exercise Test ; Flecainide ; Heart Diseases ; Humans ; Isoproterenol ; Magnetic Resonance Imaging ; Physical Examination ; Procainamide ; Tachycardia, Ventricular ; Thallium ; Tomography, Emission-Computed, Single-Photon ; Ventricular Fibrillation