Key result
IV isoproterenol suppresses hypothermia-induced electrical storm in a patient with early repolarization.
Why the study?
Triggers for ventricular fibrillation in patients with early repolarization are not fully understood, particularly during induced hypothermia.
Case Report (n=1)
No
Induced hypothermia may trigger electrical storm in patients with early repolarization, which can be effectively suppressed with intravenous isoproterenol.
Hypothermia may trigger electrical storm in early repolarization; hypothesis-generating for isoproterenol suppression, needing prospective confirmation.
BACKGROUND: Population based studies showed an association of early repolarization in the electrocardiogram (ECG) and a higher rate of sudden cardiac death presumably due to ventricular fibrillation. The triggers for ventricular fibrillation in patients with early repolarization are not fully understood. CASE PRESENTATION: We describe the case of a young patient with a survived ventricular fibrillation arrest while asleep followed by multiple episodes of recurrent ventricular fibrillation. The admission ECG showed an early repolarization pattern with substantial J-point elevation in most of the ECG-leads. After initiation of a hypothermia protocol, the patient developed an electrical storm with multiple ventricular fibrillation episodes requiring multiple cardioversions. Intravenous isoproterenol infusion successfully suppressed the malignant arrhythmia. CONCLUSION: Hypothermia appears proarrhythmic in patients with early repolarization and may trigger ventricular fibrillation. This knowledge is particularly important when initiating temperature management protocols in patients after a survived cardiac arrest. During the acute phase of an early repolarization associated electrical storm, isoproterenol is the most effective treatment suppressing the ventricular fibrillation-inducing premature ventricular complexes at higher heart rates.
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Badertscher et al. (2017) conducted a case report in Early repolarization syndrome and out-of-hospital cardiac arrest (n=1). Induced hypothermia was evaluated on Development of electrical storm. Induced hypothermia triggered an electrical storm in a patient with early repolarization, which was successfully suppressed by intravenous isoproterenol infusion.
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