To the Editor—Give to Caesar what belongs to Caesar

Published:August 20, 2022DOI:
      Escande et al
      • Escande W.
      • Gourraud J-.B.
      • Haissaguerre M.
      • et al.
      Malignant Purkinje ectopy induced by sodium channel blocker.
      recently reported the rare but reproducible occurrence of short-coupled premature ventricular complexes after the administration of sodium channel blockers (ajmaline or flecainide) in patients with suspected or documented severe idiopathic ventricular arrhythmias. These arrhythmias mostly originated from the Purkinje tissue and could be treated by ablation.
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        • Escande W.
        • Gourraud J-.B.
        • Haissaguerre M.
        • et al.
        Malignant Purkinje ectopy induced by sodium channel blocker.
        Heart Rhythm. 2022; 19: 1595-1603
        • Steinberg C.
        • Davies B.
        • Mellor G.
        • et al.
        Short-coupled ventricular fibrillation represents a distinct phenotype among latent causes of unexplained cardiac arrest: a report from the CASPER registry.
        Eur Heart J. 2021; 42: 2827-2838
        • Lador A.
        • Giudicessi J.R.
        • Barake W.M.
        • et al.
        Premature ventricular contraction-triggered ventricular fibrillation and sudden cardiac arrest in the young.
        JACC Clin Electrophysiol. 2022; 8: 380-382
        • Groeneveld S.A.
        • van der Ree M.H.
        • Mulder B.A.
        • et al.
        Prevalence of short-coupled ventricular fibrillation in a large cohort of Dutch patients with idiopathic ventricular fibrillation.
        Circulation. 2022; 145: 1437-1439
        • Tsuchiya T.
        • Nakagawa S.
        • Yanagita Y.
        • Fukunaga T.
        Transition from Purkinje fiber-related rapid polymorphic ventricular tachycardia to sustained monomorphic ventricular tachycardia in a patient with a structurally normal heart: a case report.
        J Cardiovasc Electrophysiol. 2007; 18: 102-105
        • Nagai T.
        • Suyama K.
        • Shimizu W.
        • et al.
        Pilsicainide-induced verapamil sensitive idiopathic left ventricular tachycardia.
        Pacing Clin Electrophysiol. 2006; 29: 549-552

      Linked Article

      • Malignant Purkinje ectopy induced by sodium channel blockers
        Heart RhythmVol. 19Issue 10
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          Sodium channel blocker (SCB) infusion is used to unmask the electrocardiographic pattern of Brugada syndrome. The test may also induce premature ventricular complexes (PVCs) in individuals without Brugada pattern, the clinical relevance of which is little known.
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      • Reply to the Editor— Give to Caesar what belongs to Caesar
        Heart RhythmVol. 19Issue 11
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          Belhassen and Tovia-Brodie commented on our study on malignant Purkinje ectopy after ajmaline or flecainide infusion in a cohort of patients with different ventricular arrhythmias. By making reference to Julius Caesar (The Gospels), they mention the omission of a case report by Tsuchiya et al showing polymorphic and monomorphic ventricular tachycardia induced by pilsicainide, another sodium channel blocker. Noteworthy, individual cases using doxepin (inhibitor of HERG channel), lidocaine (sodium channel blocker), atropine, isoproterenol, or electrolytic disturbance (hypokalemia) have also been reported earlier,1–3 and here we mentioned a case induced by propofol used during anesthesia.
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