Fatal ventricular fibrillation during 24-hour ambulatory electrocardiographic monitoring. A case report

Abstract

Introduction . Timely diagnosis of life-threatening ventricular arrhythmias (VAs) is important for prescribing treatment to prevent sudden cardiac death Brief description . In the presented case, the history and multiple 24-hour electrocardiographic (ECG) monitoring data of a 26-year-old female patient with VAs in the form of frequent premature ventricular contractions and nonsustained episodes of multidirectional accelerated ventricular rhythm, nonsustained episodes of ventricular tachycardia were assessed. Physical examination was not assessed due to retrospective assessment after the patient’s death. The case study was carried out using the patient’s outpatient records from birth to 26 years, extracts from the medical history, and also based on ECG monitoring data. From the age of 14 years until the moment of fatal ventricular fibrillation, repeated studies were carried out — electrocardiography, ECG monitoring, echocardiography, as well as cardiac magnetic resonance imaging. The patient was examined in medical facilities at the regional and federal levels, received the recommended combination therapy with an antiarrhythmic effect achieved, confirmed by regular ECG monitoring. However, despite the therapy, the patient experienced ventricular fibrillation, which was recorded during 24-hour ECG monitoring on the day of death. Assessment of medication adherence is not applicable in this case due to the known outcome. Discussion . Clinical follow-up demonstrates the relevance of the prevention of sudden cardiac death in patients with diagnosed VAs, as well as the need for more frequent 24-hour ECG monitorings for the timely detection of fatal tachycardias (ventricular tachycardia, ventricular fibrillation) and determination of indications for a cardioverter-defibrillator implantation.