title: Noncoronary ST elevation and polymorphic ventricular tachycardia during left-sided accessory pathway ablation.
abstract: BACKGROUND
  An early repolarization (ER) pattern on electrocardiogram (ECG) sometimes has the risk of polymorphic ventricular tachycardia (PVT) or ventricular fibrillation (VF). An abnormal ER pattern can develop in various experimental or clinical situations. We experienced 4 cases of abnormal ER pattern with or without PVT during the radiofrequency (RF) ablation of the left accessory pathway.
  
  
  RESULTS
  An electrophysiologic study and RF ablation were performed in 4 patients. Four patients had atrioventricular reentrant tachycardia. During RF ablation of the left accessory pathway, severe chest pain developed and was followed by abnormal J-point elevation. During the ongoing chest pain and J-point elevation, coronary angiograms showed normal findings. The chest pain and J-point elevation were followed by PVT or VF that was unresponsive to defibrillation. The PVT was spontaneously terminated and repeated. After 0.5 mg atropin was given, chest pain and ECG change disappeared.
  
  
  CONCLUSIONS
  The mechanisms of ER syndrome during RF ablation might be increased vagal tone due to chest pain or direct vagal stimulation.
authors.affiliation: Department of Cardiology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Gyo-Seung
authors.initials: GS
authors.lastname: Hwang
authors.forename: Jin-Sun
authors.initials: JS
authors.lastname: Park
authors.forename: Hyoung-Mo
authors.initials: HM
authors.lastname: Yang
authors.forename: Hong-Seok
authors.initials: HS
authors.lastname: Lim
authors.forename: Byoung-Joo
authors.initials: BJ
authors.lastname: Choi
authors.forename: So-Yeon
authors.initials: SY
authors.lastname: Choi
authors.forename: Myeong-Ho
authors.initials: MH
authors.lastname: Yoon
authors.forename: Joon-Han
authors.initials: JH
authors.lastname: Shin
authors.forename: Seung-Jea
authors.initials: SJ
authors.lastname: Tahk
mesh_terms: D058606:Accessory Atrioventricular Bundle / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001285:Atropine / Q000627:therapeutic use; D017115:Catheter Ablation / Q000009:adverse effects*; D017023:Coronary Angiography; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000187:drug effects / Q000503:physiopathology; D055815:Young Adult
chemical_list: D000889:Anti-Arrhythmia Agents; D001285:Atropine
keywords: catheter ablation early repolarization syndrome; polymorphic ventricular tachycardia; vagal nerve stimulation; ventricular fibrillation