title: Gitelman's syndrome with exercise-induced ventricular tachycardia.
abstract: A 62-year-old female with palpitations was admitted to hospital where she recorded 12,299 monofocal ventricular premature contractions (VPCs) in 24 h and nonsustained ventricular tachycardia (VT) on exertion. She had hypokalemia with renal potassium wasting, a chloride-resistant metabolic alkalosis, elevated plasma renin, elevated plasma aldosterone (relative to the serum K concentration), hypomagnesemia with renal magnesium wasting, decreased urine calcium excretion, and normal blood pressure. The hypokalemia and hypomagnesemia were thought to have precipitated the VT. The coronary angiogram showed normal coronary arteries; however, the left ventriculogram revealed akinesis of the posterolateral wall. Because the VT could not be induced by programmed electrical stimulation either before or during intravenous administration of isoproterenol, the VPC with the same QRS morphology as the VT became the target of radiofrequency catheter ablation (RF-CA). Intracardiac mapping showed that the earliest activation site was situated in the asynergic area of the left ventricle (LV) and radiofrequency catheter ablation directed at the LV asynergy area completely eliminated the VPCs without any complications. During the follow-up period (6 months), she was free from palpitation and VT was not clinically documented.
authors.affiliation: Third Division, Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Eisaku
authors.initials: E
authors.lastname: Nakane
authors.forename: Tatsuji
authors.initials: T
authors.lastname: Kono
authors.forename: Yosio
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Tokaji
authors.forename: Takahide
authors.initials: T
authors.lastname: Ito
authors.forename: Koichi
authors.initials: K
authors.lastname: Sohmiya
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sakai
authors.forename: Michihiro
authors.initials: M
authors.lastname: Suwa
authors.forename: Takao
authors.initials: T
authors.lastname: Tanaka
authors.forename: Hikaru
authors.initials: H
authors.lastname: Nisimura
authors.forename: Yasusi
authors.initials: Y
authors.lastname: Kitaura
mesh_terms: D017115:Catheter Ablation; D004562:Electrocardiography; D015444:Exercise; D005260:Female; D006801:Humans; D007008:Hypokalemia / Q000150:complications*; D008275:Magnesium Deficiency / Q000150:complications*; D008875:Middle Aged; D015635:Radionuclide Ventriculography; D013577:Syndrome; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*