Naveed Akhtar, Mehnaz Mehboob, Muhmmad Toqeer Alam.
Iatrogenic ventricular fibrillation in a patient with pre-excited atrial fibrillation.
Pak J Cardiol Jan ;16(1):50-2.

A 23-year-old gentleman presented with sudden onset of palpitations and chest pain. The patient had been symptomatic for the past one year. Patient did not have any other significant past medical history. Patient was hemodynamically stable and clinical examination was normal except for tachycardia. The patient was transferred to coronary care unit and 12 lead electrocardiogram was performed, which showed a broad complex tachycardia with a variable R-R interval. Occasional narrow complex beats were also evident. Diagnosis of preexcited atrial fibrillation was suspected and as procainamide was not available, it was decided to electrically cardiovert the patient under a brief general anesthesia. A single synchronized shock of 100 Joules was administered. This induced ventricular fibrillation. A further 360 Joules DC shock successfully cardioverted the patient to sinus rhythm. The post cardioversion 12 lead ECG confirmed the classical features of WPW syndrome i.e. the short PR interval and delta waves. The patient subsequently underwent electrophysiological studies with successful radio frequency ablation of the left posterior accessory pathway. Post ablation ECG showed loss of delta waves and the patient remained symptom free during the regular follow-ups.

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