A 52‐year‐old man was admitted due to out‐hospital cardiac arrest. Recurrent ventricular fibrillation (VF) occurred under therapeutic hypothermia thereafter. Previously inadverted full pre‐excitation was documented exclusively and immediately prior to 4 out of the 5 VF relapses. Coronary vasospasm and early repolarization were also documented. An electrophysiological study demonstrated poor anterograde conduction over a left‐sided accessory pathway. We theorize that maximum pre‐excitation favored in‐hospital VF by augmenting the repolarization vulnerability induced by therapeutic hypothermia, with coronary vasospasm accounting as the probable cause of out‐hospital VF. A plausible VF mechanism in WPW syndrome unrelated to pre‐excited atrial fibrillation is discussed.

中文翻译：

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Wolff-Parkinson-White 综合征患者的心室颤动与预激性心房颤动无关

一名 52 岁男性因院外心脏骤停入院。此后在治疗性低温下发生复发性心室颤动 (VF)。5 次 VF 复发中的 4 次之前无意识地完全预激被专门记录在案。冠状动脉痉挛和早期复极也被记录在案。一项电生理学研究表明，左侧旁路的顺行传导较差。我们的理论是，通过增加治疗性低温引起的复极脆弱性，最大预激有利于院内 VF，冠状血管痉挛被认为是院外 VF 的可能原因。讨论了与预激性心房颤动无关的 WPW 综合征中可能的 VF 机制。