Ventricular Fibrillation Diagnosed During Electrophysiological Study for Non-Sustained Tachycardia

HISADA T, MIYAGAWA T, YAKUSHIJI T, TSUJIMOTO T, SAKAI M, ADACHI T, IKEWAKI K, OGATA K, OFISUZU F, SAKURAI Y. Ventricular fibrillation diagnosed during electrophysiological study for non-sustained tachycardia. Aviat Space Environ Med 2010; 81:593-6. Ventricular fibrillation diagnoses such as Brugada syndrome pose a risk of sudden incapacitation or death in aircrew. This case report presents a 44-yr-old male fighter pilot who unexpectedly developed ventricular fibrillation (VF) during an electrophysiological study (EPS) prior to therapy for non-sustained ventricular tachycardia (nsVT). The initial aeromedical disposition for this case was "qualified for flying duties," with the restriction that he must fly with another pilot due to repeatedly observed nsVT. This pilot wanted to return to flight duty in single-seat aircraft without any restrictions. Therefore, this patient decided to undergo catheter therapy for nsVT. Unexpectedly, not VT but VF was induced by catheter manipulation during EPS. Pilsicainide-induced coved-type ST wave elevation consistent with Brugada syndrome was noted in this patient's electrocardiogram. He was ultimately disqualified due to the diagnosis of VF. This report suggests EPS on rare occasions may uncover another severe disease similar to this case report.