Sudden nocturnal death in two apparently healthy young Japanese males (Pokkuri disease) was precipitated by ventricular flutter and fibrillation following R-on-T ectopic ventricular beats.
Case Report (n=2)
Highlights ventricular flutter as a mechanism for sudden nocturnal death (pokkuri disease) in young males without structural heart disease.
Two young males who had no organic heart disease died unexpectedly during the night. In one patient, the monitor ECG showed a sinoatrial block and the electrophysiologic study revealed a sinoatrial conduction time at the upper limit of normal and a prolonged PA interval. The surface ECG showed left axis deviation. Ventricular ectopic beats were confined to the night when he died from ventricular flutter. The ECG of the other patient was normal except for the change in QRS configuration found when the preceding RR interval was prolonged, suggesting a phase 4 block in intraventricular conduction. He was completely free from arrhythmia except for the ventricular ectopic beats which developed around 9:00 p.m. and the ventricular flutter following an R-on-T type ventricular ectopic beat which resulted in death during the night. The autopsy showed no organic heart disease. ST elevation suggestive of acute ischemia was not found and the QT intervals were normal in both cases. No electrolyte imbalances were found. These 2 cases can be diagnosed as pokkuri disease which is well known in Japan. The victims are exclusively young males who have no apparent diseases to which death can be attributed.
Hayashi et al. (Tue,) conducted a case report in Pokkuri disease (Sudden nocturnal death) (n=2). R-on-T ventricular ectopic beats leading to ventricular flutter was evaluated on Sudden cardiac death. Sudden nocturnal death in two apparently healthy young Japanese males (Pokkuri disease) was precipitated by ventricular flutter and fibrillation following R-on-T ectopic ventricular beats.