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Ventricular Fibrillation Resulting from Synchronized Internal Atrial Defibrillation in a Patient with Ventricular Preexcitation

VF After Synchronized Internal Atrial Defibrillation. This case describes ventricular proarrhythmia as a result of a synchronized internal atrial defibrillation shock in a 29‐year‐old man with Ebstein's anomaly referred for radiofrequency ablation of a right posterior accessory pathway. During the electrophysiologic study, atrial fibrillation was induced and 3/3 msec shocks of various strengths were delivered between two decapolar defibrillation catheters in the coronary sinus and right atrial appendage. A 2.0‐J biphasic shock synchronized to an R wave after a short‐long‐short ventricular cycle length pattern with a preshock coupling interval of 245 msec induced ventricular fibrillation, which was externally defibrillated with 200 J. This observation has implications for the development of implantable atrial defibrillators.