Prodromal Ventricular Premature Beats Preceded by a Diastolic Wave

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Abstract
In a prospective study of quinidine syncope, 71 patients with atrial fibrillation/flutter were ECG monitored for 4 days after the start of quinidine therapy. Six patients developed ventricular tachycardia (VT) or ventricular fibrillation (VF) during the first 48 h in sinus rhythm. Q-T prolongation was seen in most patients with and without VT/VF and was non-predictive in this respect. A diastolic wave (DW) of larger amplitude than the preceding T wave and usually followed by a ventricular premature beat (VPB) appeared in 5 of the 6 VT/VF patients (13-185 min before the 1st event) and in none of the remaining 63 patients reaching sinus rhythm. For comparison, 2 cases and 9 from the literature with idiopathic long Q-T or alternating T wave syndromes were studied for DW-VPB. They were found in all 10 cases with a VPB recording, but among 19 patients with acute myocardial infarction and VT/VF no such case was seen. VT/VF was more common after large and VPB after small amplitude DW; whether the DW precedes and initiates the ventricular tachyarrhythmias was discussed.