Ventricular ectopy during REM sleep: implications for nocturnal sudden cardiac death.
BACKGROUND
A young adult female presented with syncope and periodic weakness. A 12-lead electrocardiogram showed frequent premature ventricular contractions and prolonged QU interval. Repetitive runs of nonsustained ventricular tachycardia were recorded at night.


METHODS
Electromyography, muscle biopsy, MRI, echocardiography, exercise stress testing using Bruce protocol with microvolt T-wave alternans testing, 24 h Holter monitoring, electrophysiological testing and examination of the effects of sleep and sleep stage on the patient's ventricular arrhythmias.


METHODS
Type 1 Andersen-Tawil syndrome, (also known as type 7 long QT syndrome). Severe ventricular arrhythmia was observed, predominantly during rapid eye movement sleep. We speculate that the autonomic instability present during rapid eye movement sleep precipitates increasing vulnerability to sleep-related ventricular tachycardia.


RESULTS
Beta-blocker therapy alone, subsequently combined with mexiletine treatment.
Garcia-Touchard
Arturo
A
Mayo Clinic College of Medicine in Rochester, Minnesota 55905, USA.
Somers
Virend K
VK
Kara
Tomas
T
Nykodym
Jiri
J
Shamsuzzaman
Abu
A
Lanfranchi
Paola
P
Ackerman
Michael J
MJ
D000293:Adolescent; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001706:Biopsy; D016757:Death, Sudden, Cardiac / Q000209:etiology* / Q000517:prevention & control; D003937:Diagnosis, Differential; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D004576:Electromyography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008801:Mexiletine / Q000627:therapeutic use; D018482:Muscle, Skeletal / Q000473:pathology / Q000503:physiopathology; D017286:Polysomnography; D012895:Sleep, REM / Q000502:physiology*; D018879:Ventricular Premature Complexes / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology
D000889:Anti-Arrhythmia Agents; D008801:Mexiletine