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A 39 year old woman was admitted for evaluation of recurrent syncope. A detailed workup, including invasive electrophysiological testing, was unremarkable. The patient initially refused implantation of a loop recorder, but finally agreed eight months later, after a further syncopal episode. Two years later, the patient was referred to our clinic for device explantation because of battery depletion. Without contacting our clinic, the patient had documented two short episodes of light headedness a few months after device implantation, corresponding with two episodes of non-sustained, fast, polymorphic ventricular tachycardia. The subsequently implanted automatic defibrillator revealed recurrent aymsptomatic episodes of non-sustained polymorphic ventricular tachycardia during the follow up of 10 months. The upper panel shows a normal sinus rhythm followed by a short run of non-sustained ventricular tachycardia (start and finish indicated by arrow) initiated by a couplet of ventricular extrasystoles (asterisks). The lower panel shows a continuation of the ECG; some sinus beats are followed by ventricular extrasystoles (bigemini) (paper speed 25 mm/s; 25 mm/mV).
In conclusion, potentially life threatening polymorphic ventricular tachycardia in this young woman without structural heart disease and recurrent syncope could only be diagnosed by means of an implantable loop recorder.