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Idiopathic Ventricular Fibrillation and Early Repolarization

  • Pieter G. Postema
Chapter
Part of the Cardiac and Vascular Biology book series (Abbreviated title: Card. vasc. biol.)

Abstract

In this chapter, an overview is provided on idiopathic ventricular fibrillation (IVF) and early repolarization. Idiopathic ventricular fibrillation is a tragic and notoriously difficult disease entity to manage. The IVF patients in whom a cardiac arrest occurs are generally considered healthy and do not show any currently identifiable abnormalities that denote their increased risk for malignant and life-threatening arrhythmias. Importantly, IVF can be inheritable and tear through families. The number of patients who survive their first manifestation of the disease is low, and the recurrence rate of IVF is appreciable. Treatment in patients who survived their event is performed by implantation of a cardioverter defibrillator (ICD) and a decrease of the risk of IVF recurrence may be achieved by prescription of quinidine. During a VF storm, administration of isoproterenol can be essential, and possibly also sedation might be effective. Research into the origin and genetic underpinning of IVF is limited by its malignant character, yet has revealed genetic variants in the DPP6 gene and CALM1 gene that impact on cellular cardiac electrophysiology. In contrast, early repolarization is a description of electrocardiographic variants with elevation, slurring, or notching in the terminal QRS complex or early ST segment. Although considered a benign electrocardiographic characteristic for many decades, in the past decade associations have been made with a propensity to sudden cardiac arrest by VF. Importantly, early repolarization is of very common occurrence in many young and healthy individuals. The description of a rare malignant association has spurred scientific interest in this phenomenon. Fortunately, its benign prognosis is still valid for the vast majority of individuals who display an early repolarization pattern. The challenge for the future will be to delineate benign from malignant variants of early repolarization, the development of aids in risk stratification and a better understanding underlying pathophysiology on cellular and genetic level, to further guide clinicians and patients.

Keywords

Idiopathic ventricular fibrillation Early repolarization Sudden death Cardiac arrest 

Notes

Compliance with Ethical Standards

Sources of Funding

None.

Conflict of Interest

None.

Ethical Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Clinical and Experimental Cardiology, Heart Centre, Academic Medical CentreUniversity of AmsterdamAmsterdamThe Netherlands

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