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ABSTRACT
The authors describe a patient with ventricular fibrillation associated with right bundle branch block-like QRS morphology and persisting ST segment elevation in the precordial leads, in whom the morphology of the ST segment changed from the coved type to the saddle-back type or vice versa on a beat-to-beat basis. Such an observation has never been reported in the previous literature.
Introduction
Ventricular arrhythmias and/or sudden death associated with right bundle branch block (RBBB)like morphology and persistent ST segment elevation in the right precordial leads have been defined as a distinct clinical syndrome.' Although the cause of the electrical instability of this syndrome was poorly defined, the morphology and the severity of the ST segment elevation were known to be influenced by the autonomic nervous system and to vary daily or sometimes hourly.2,3 We present a patient with this rare syndrome in whom beat-to-beat change of the morphology of the ST segment was observed during the unstable period between each episode of recurrent and refractory ventricular fibrillation (Vf).
Case Report
A 33-year-old male traveler was taken to the emergency room because of a first episode of syncope. The patient had no history of heart disease, and the family history was not remarkable. The patient developed syncope while taking a rest in his hotel room after sightseeing. On his way to the emergency room, he lost consciousness twice for a brief period of time but recovered spontaneously. On arrival to the emergency room, he became unconscious again but recovered spontaneously while nurses were trying to put a monitor on him. Initial blood pressure was 95/70 mmHg, respiratory rate was 20/min,...