Key result
Direct-current cardioversion of preexcited atrial fibrillation caused iatrogenic ventricular fibrillation in 2 patients due to inadvertent T-wave synchronization, rescued by immediate defibrillation.
Case Report (n=2)
Inadvertent T-wave synchronization during cardioversion of preexcited AF can cause iatrogenic VF, requiring rapid recognition and unsynchronized defibrillation.
May warrant caution against T-wave synchronization in preexcited AF cardioversion; case reports leave open prospective safety protocols.
Direct-current cardioversion is an important means of managing arrhythmias. During treatment, carefully synchronizing energy delivery to the QRS complex is necessary to avoid ventricular fibrillation caused by a shock during the vulnerable period of ventricular repolarization, that is, a shock on the T wave. The presence of an accessory pathway and ventricular preexcitation can lead to difficulty in distinguishing the QRS complex from the T wave because of bizarre, wide, irregular QRS complexes and prominent repolarization. We present the cases of 2 patients who had iatrogenic ventricular fibrillation from inappropriate T-wave synchronization during direct-current cardioversion of preexcited atrial fibrillation. Our experience shows that rapidly recognizing the iatrogenic cause of VF and immediate treatment with unsynchronized defibrillation can prevent adverse clinical outcomes.
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Kaufmann et al. (2018) conducted a case report in Preexcited atrial fibrillation (n=2). Direct-current cardioversion (with inadvertent T-wave synchronization) was evaluated on Iatrogenic ventricular fibrillation. Direct-current cardioversion of preexcited atrial fibrillation caused iatrogenic ventricular fibrillation in 2 patients due to inadvertent T-wave synchronization, rescued by immediate defibrillation.
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