Implantable Cardioverter-defibrillator Therapy for Syncope: An Educational Example of a Multicomponent Electrocardiographic Differential Diagnosis and the Application of Clinical Trial Data to an Individual Patient

This is a report of a patient with a history of hypertension and myocardial infarction and a left ventricular ejection fraction of 35% who suffered a syncopal event. Her admitting electrocardiogram was compatible with her old myocardial infarction, an anteroseptal left ventricular aneurysm, left ventricular hypertrophy, and short-QT syndrome. The present report discusses how each of these might contribute individually and to some extent synergistically to producing syncope. She was treated with an implantable cardioverter-defibrillator (ICD), though she did not meet strict Multicenter Automatic Defibrillator Implantation Trial (MADIT), MADIT II, and Multicenter Unsustained Tachycardia Trial (MUSTT) patient characteristics. Her implant, however, was consistent with the 2014 Heart Rhythm Society/American College of Cardiology/American Heart Association consensus document regarding patients who do not match clinical trial enrollees but for whom ICD consideration is appropriate.