Sudden death during ambulatory monitoring. Clinical and electrocardiographic correlations. Report of a case.

Abstract

A man with known coronary heart disease underwent treadmill exercise testing to determine his functional capacity. The rest was negative for ischemia. Ventricular ectopic activity was noted at rest and in the recovery period. On the same day, while viewing a sporting event at home, the patient died suddenly. An ambulatory ECG recording documented ventricular fibrillation as the terminal mechanism. Ventricular ectopic activity and heart rate increased 2 h prior to death, and ischemic ST-segment depression was noted at the time of the terminal arrhythmia. Myocardial ischemia and catecholamine response probably lowered the threshold to ventricular fibrillation, thus facilitating the emergence of the fatal arrhythmia.