title: Catecholaminergic polymorphic ventricular tachycardia associated with sinus node dysfunction and junctional rhythm: Case report and literature review.
abstract: We report the case of a 38-year-old woman with history of syncope and polymorphic ventricular tachycardia; tachycardia was inducible at exercise stress test, not at electrophysiologic study. Phases of QT prolongation were found at ambulatory electrocardiogram monitoring. The woman came to our attention for periodic control of implantable loop recorder. Rest electrocardiogram at admission unexpectedly showed sinus bradycardia, junctional rhythm, and ventricular premature beats. Furthermore, loop recorder control revealed a short run of bidirectional tachycardia, not associated with syncope. Final diagnosis was catecholaminergic polymorphic ventricular tachycardia, and the patient was implanted with an ICD. We therefore report an unusual case of bidirectional ventricular tachycardia associated with sinus node dysfunction and junctional escape rhythm. We hypothesize that a diffuse dysfunction of cardiac conduction system, presumably based on diffuse disorder of calcium handling, may be responsible for both sinus node failure and ventricular tachycardia.
authors.affiliation: Department of Medical & Surgical Sciences, University of Foggia, Italy. Electronic address: natale.brunetti@unifg.it.
authors.forename: Natale Daniele
authors.initials: ND
authors.lastname: Brunetti
authors.affiliation: Ospedali Riuniti University Hospital, Foggia, Italy.
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Pellegrino
authors.affiliation: Ospedali Riuniti University Hospital, Foggia, Italy.
authors.forename: Girolamo
authors.initials: G
authors.lastname: D'Arienzo
authors.affiliation: Department of Medical & Surgical Sciences, University of Foggia, Italy.
authors.forename: Rafel
authors.initials: R
authors.lastname: Sai
authors.affiliation: Ospedali Riuniti University Hospital, Foggia, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Ziccardi
authors.affiliation: Asklepios Klinik Sankt Georg, Hamburg, Germany.
authors.forename: Francesco
authors.initials: F
authors.lastname: Santoro
authors.affiliation: Department of Medical & Surgical Sciences, University of Foggia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gaglione
authors.affiliation: Department of Medical & Surgical Sciences, University of Foggia, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Di Biase
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008133:Long QT Syndrome / Q000150:complications* / Q000175:diagnosis*; D012804:Sick Sinus Syndrome / Q000150:complications* / Q000175:diagnosis*; D017180:Tachycardia, Ventricular / Q000150:complications* / Q000175:diagnosis*; D000098850:Polymorphic Catecholaminergic Ventricular Tachycardia
keywords: Catecholaminergic polymorphic ventricular tachycardia; Junctional rhythm; Sinus node dysfunction