Case Presentation:
Our patient was a 33-year-old black female with a past medical history
of Brugada syndrome, she had a St Jude Implantable cardiac defibrillator
(ICD) implanted in 2009. Despite her ICD placement, subsequent
Radiofrequency ablation (RF) ablation in 2013 and quinidine therapy she
remained with persistent atrial fibrillation. She presented to the
Emergency Department (ED) with complaints of midsternal non-exertional
chest pain and shortness of breath. Initial EKG demonstrated atrial
fibrillation with controlled ventricular rate and inferior lateral
T-wave inversions. Troponin levels were negative. The patient
subsequently went into pulseless VT and despite attempted ablation, she
remained in VT. She received multiple rounds of CPR with defibrillation
until return of spontaneous circulation (ROSC) was achieved. The patient
was intubated and placed on ECMO via right femoral access.
Cardiothoracic Surgery was consulted to perform a BCSD.