Short-coupled premature ventricular contractions triggering malignant arrhythmias

Introduction: Some malignant ventricular arrhythmias are triggered by short-coupled ventricular premature contractions. Objective: To characterize patients with syncopal events or sudden death due to malignant ventricular arrhythmias triggered by this type of premature complexes. Method: There were studied 29 subjects, 16 women and 13 men, with an average age of 38, with and without structural heart disease, whether they received or not antiarrhythmic drugs, with events of sudden or syncopal death from malignant arrhythmias triggered by short-coupled ventricular premature contractions. Clinical history, electrical sequences, echocardiogram, telemetry, ergometry, coronary angiography, pharmacological tests, and programmed electrical stimulation were evaluated, if necessary. Results: The most common presentation of sudden death was of 89.6%. Ventricular fibrillation was the most frequent arrhythmia (20 events), followed by helical ventricular tachycardia and others. The coupling was ultra-short in 59.4% and short in 40.6%. In 61.5%, sudden death events were triggered by ultra-short premature ventricular complexes, after that, they are considered high risk. The treatments were the cardioverter-defibrillator, antiarrhythmic drugs or their suppression, and others. There were two deaths, both without cardioverter. Conclusions: Short-coupled ventricular premature contractions are premonitory electrical markers and trigger of malignant ventricular arrhythmias and sudden death in patients with and without structural heart disease. The lower the degree of coupling, the greater the frequency of malignant arrhythmias and sudden death. This is an important factor for the risk stratification of premature ventricular complexes, but it is not the only one.