title: Inadvertently Developed Ventricular Fibrillation during Electrophysiologic Study and Catheter Ablation: Incidence, Cause, and Prognosis.
abstract: OBJECTIVE
  Ventricular fibrillation (VF) can inadvertently occur during electrophysiologic study (EPS) or catheter ablation. We investigated the incidence, cause, and progress of inadvertently developed VF during EPS and catheter ablation.
  
  
  METHODS
  We reviewed patients who had developed inadvertent VF during EPS or catheter ablation. Patients who developed VF during programmed ventricular stimulation to induce ventricular tachycardia or VF were excluded.
  
  
  RESULTS
  Inadvertent VF developed in 11 patients (46.7±9.3 years old) among 2624 patients (0.42%); during catheter ablation for atrial fibrillation (AF) in nine patients, frequent ventricular premature beats (VPBs) in one, and Wolff-Parkinson-White (WPW) syndrome were observed in one. VF was induced after internal cardioversion in six AF patients due to incorrect R-wave synchronization of a direct current shock. Two AF patients showed spontaneous VF induction during isoproterenol infusion while looking for AF triggering foci. The remaining AF patient developed VF after rapid atrial pacing to induce AF, but the catheter was accidentally moved to the right ventricular (RV) apex. A patient with VPB ablation spontaneously developed VF during isoproterenol infusion. The focus of VPB was in the RV outflow tract and successfully ablated. A patient with WPW syndrome developed VF after rapid RV pacing with a cycle length of 240 ms. Single high energy (biphasic 150-200 J) external defibrillation was successful in all patients, except in two, who spontaneously terminated VF. The procedure was uneventfully completed in all patients. At a mean follow-up period of 17.4±15.5 months, no patient presented with ventricular arrhythmia.
  
  
  CONCLUSIONS
  Although rare, inadvertent VF can develop during EPS or catheter ablation. Special caution is required to avoid incidental VF during internal cardioversion, especially under isoproterenol infusion.
authors: Division of Cardiology, Korea University College of Medicine, Seoul, Korea.
authors: Yae Min
authors: YM
authors: Park
authors: Hyun Soo
authors: HS
authors: Lee
authors: Ra Seung
authors: RS
authors: Lim
authors: Jong-Il
authors: JI
authors: Choi
authors: Hong Euy
authors: HE
authors: Lim
authors: Sang Weon
authors: SW
authors: Park
authors: In Suck
authors: IS
authors: Choi
authors: Young-Hoon
authors: YH
authors: Kim
keywords: Catheter ablation; Electrophysiologic study, cardiac; Ventricular fibrillation
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