Case 34-1996: A 50-Year-Old Woman with Cardiac Disease, an Electronic Pacemaker, and Cardiac Arrest in Ventricular Fibrillation

Presentation of Case A 50-year-old woman was admitted to the hospital because of cardiac arrest in ventricular fibrillation. She had been in excellent health until four years earlier, when she abruptly lost consciousness. Evaluation elsewhere revealed complete heart block. An electronic cardiac pacemaker, in DDD mode, was implanted, with symptomatic improvement. Three and a half years before admission, the patient had exertional dyspnea and tachycardia. Disopyramide was administered, but ventricular fibrillation developed within a week; the drug was discontinued. Cardiac ultrasonography showed a dilated left ventricle, with akinesis of the anterior wall, the middle-to-distal portion of the septum, and the . . .