Short-Coupled Idiopathic Ventricular Fibrillation A Literature Review With Extended Follow-Up

Idiopathic ventricular fibrillation is responsible for approximately 5%-7% of cases of aborted cardiac arrest. Recent studies have shown that short-coupled ventricular premature complexes are present at the onset of idiopathic ventricular fibrillation in 6.6%-17% of patients. The present review provided information on 86 patients with short-coupled ma-lignant ventricular arrhythmias that were reported as case reports or small patient series during the last 70 years. In 75% of the 81 cases published during the last 40 years, extended information and follow-up (from 2.63 +/- 4.5 years to 10.67 +/- 7.8 years; P < 0.001, between the original publication to the latest update) could be obtained from the authors. The review shows that short-coupled malignant ventricular arrhythmias occurred almost equally in males and females, at the mean age of 40 years. A tendency for later occurrence of the arrhythmia by 4 years was observed in females. A prior history of syncope was noted in 45.3% of the patients, whereas arrhythmic storm occurred in 42% at presentation. The most common mode of revelation of short-coupled malignant ventricular arrhythmias was syncope (53.5%), followed by aborted cardiac arrest (26.7%) and recurrent arrhythmic event after prior implantable-cardioverter defibrillator implantation for idiopathic ventricular fibrillation (17.4%). For the first time, short-coupled malignant arrhythmias exhibiting not-so-short coupling intervals ($350 milliseconds) were found in a significant proportion of patients (17.4%). During long-term follow-up, quinidine yielded a slightly higher success rate in arrhythmia control than ablation. Larger studies are necessary to assess the best strategy for the management of this potentially lethal arrhythmia. (J Am Coll Cardiol EP 2022;8:918-936) (c) 2022 by the American College of Cardiology Foundation.

Automated summary

Idiopathic ventricular fibrillation is an important cause of cardiac arrest, and studies have shown the presence of short-coupled ventricular premature complexes in some patients. A review of 86 cases found that short-coupled malignant ventricular arrhythmias occurred almost equally in males and females, with an average age of 40 years. Syncope was the most common presentation, and quinidine showed slightly better control of arrhythmia than ablation during long-term follow-up.