Gitelman's Syndrome With Exercise-Induced Ventricular Tachycardia

A 62-year-old female with palpitations was admitted to hospital where she recorded 12,299 monofocal ventricular premature contractions (VPCs) in 24 h and nonsustained ventricular tachycardia (VT) on exertion. She had hypokalemia with renal potassium wasting, a chloride-resistant metabolic alkalosis,...

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Bibliographic Details
Published in:Circulation Journal 2004, Vol.68(5), pp.509-511
Main Authors: Nakane, Eisaku, Kono, Tatsuji, Sasaki, Yosio, Tokaji, Yasunobu, Ito, Takahide, Sohmiya, Koichi, Sakai, Yasuhiko, Suwa, Michihiro, Tanaka, Takao, Nisimura, Hikaru, Kitaura, Yasusi
Format: Article
Language:English
Subjects:
Catheter Ablation
Electrocardiography
Exercise
Female
Gitelman's syndrome
Humans
Hypokalemia - complications
Magnesium Deficiency - complications
Middle Aged
Radionuclide Ventriculography
Syndrome
Tachycardia, Ventricular - diagnosis
Tachycardia, Ventricular - etiology
Tachycardia, Ventricular - therapy
Ventricular tachycardia
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Summary:A 62-year-old female with palpitations was admitted to hospital where she recorded 12,299 monofocal ventricular premature contractions (VPCs) in 24 h and nonsustained ventricular tachycardia (VT) on exertion. She had hypokalemia with renal potassium wasting, a chloride-resistant metabolic alkalosis, elevated plasma renin, elevated plasma aldosterone (relative to the serum K concentration), hypomagnesemia with renal magnesium wasting, decreased urine calcium excretion, and normal blood pressure. The hypokalemia and hypomagnesemia were thought to have precipitated the VT. The coronary angiogram showed normal coronary arteries; however, the left ventriculogram revealed akinesis of the posterolateral wall. Because the VT could not be induced by programmed electrical stimulation either before or during intravenous administration of isoproterenol, the VPC with the same QRS morphology as the VT became the target of radiofrequency catheter ablation (RF-CA). Intracardiac mapping showed that the earliest activation site was situated in the asynergic area of the left ventricle (LV) and radiofrequency catheter ablation directed at the LV asynergy area completely eliminated the VPCs without any complications. During the follow-up period (6 months), she was free from palpitation and VT was not clinically documented. (Circ J 2004; 68: 509 - 511)
ISSN:1346-9843
1347-4820
DOI:10.1253/circj.68.509