Editorial Comment

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Refractory Ventricular Fibrillation in the Electrophysiology Laboratory: A Nightmare From Which We Can Awaken* KOONLAWEE

NADEMANEE.

\oll

electrophysiology

when

it was confined

nk

research

centers.

programs

to become

in diagnosing

arrhythmias progras

and over

technologic a better

This evolution

and treating

sudden

a span

cardiac of 20

developments

from

rccordmg

an integral

in most hospitals.

ils success

tory,

has evolved

it*

~cnwculdr

death.

years

can

understanding

of arrhythmia

cardrac to

laboraand

effective new antiarrhythmic therapie\ mcludmg ;!bl;d on of the arrhythmia foci (21 and the automatic implantable cardioverier-defibrillator (AICDI (31. In the IYYO; electmphvciology has come into its own a< a diwpline. lndueed ventricular tachyrardia/fibrillation in the electrophysidogy laboratory. In the western world where aschemtc heart disease is prevalent. more patnents are being referred for

electrophysiologic

study.

and

the

majority

four or even

procedures

before

more

ventricular

an effective

tachycardna

therapy

is found

induction (if onl: 15

found). the total number of procedures is increasing. Yet ventricular tachycardia induction is not risk free. When we began doing these studies in the early IY705. many of us had great reservations about inducing mahgnant arrhythmias to treat arrhythmias. ‘Then It was a novel and unorthodox

approach:

.a standard

practice.

dence.

we perhaps

today

electrophyslologwr

As we gained grew

somewhat

accept

of ihe Journal

leadmp.

I,

experience

and confi-

accustomed

to the po-

undergo

is Emall.

fibrillation.

s!udn

aho

studies

have

accondary Ibcitemra.

or

Another

reason

worsen

the

mortality

Even

f&ton

arrhythmias

condmon:

as electrolyte acidosis)

arc

im-

that may

typically

II that the electrophyaiolog!

and

undergoing

m stable

I\uch

hyporemia.

from

so. why are

is that paoents

are ucually

ventric-

data come

highsr elsewhere.

One reason

chronic

promote

6br~llarmn

consscutire

There

labolatorio:

may &

?G this

et al. (6, re!ate that four panems

induction

rata

an

refractory

in 8.145 elecrrophyrn!ol;i

died I” a toral of I.215

w fen deaths’!

balance.

mduccd Fibrillation

who dieo. only two had ref::c-

Cohen

elccrrophywlogic Iho\e

who

develop

five deaths

elecirophyriology

morbld8ty

i\ rare but it does

of patients

ventriculartachycardiaiventncular

rach\cdrdia

be-

Often patient,

,b,r ,e\,.

IachycarJidivcntricular

evzluded. id:,o-z%r!

is

designed. aalied and eqwpped to ensure prompt defihnllnlion. Derpue these precautmnx. the fxl remiGns lhat a few paumrc uill develop mdoced refectory vsnhicular tachycardld~emr~cular fihrdlotion. and home of them will dlc. It is an eiecrrowhvsloloast’s

of these

patients are prone to development of recurrent ventricular tachycardia and ventricular fibrillation (4). Many cardiologists consider electmphysiologic druz testing the best way of finding an etfective antiarrhythmic regimen for there patients. And because it is not unusual for a patient to undergo three,

!\\oc

lhrrc

remarkable

be attributed mechanlwn

I51 reported

(enlr~culx

especially

mnes

arrhythmia

and

of rhe five pauesr,

wry

uix

B” tnduced mahgnant arto therapy.

number study

and one pauent

due 10

in the eleclrophysmlogy

e~acl

had rsfrxiory

a few

part of cardmlogy

Such

couid d,e fmm

,n other

and their families