Late Cardiac Perforation After Percutaneous Closure of an Atrial Septal Defect Using an Amplatzer Device

catecholamines. Verapamil, which should not usually be administered for the treatment of wide QRS complex tachycardia, was used in this patient, following consultation with the arrhythmia specialist, as the pattern clearly indicated a fascicular origin, in the presence of normal ventricular function. The efficacy of verapamil may support an abnormal sinoatrial node pacemaker activity mechanism dependent on Ca channels. Adenosine could also be effective for this mechanism, but would not be indicated in incessant VT, due to its fleeting effects. This case shows the importance of a broad differential diagnosis, when the clinical presentation is unusual. The presence of incessant VT of fascicular appearance could have led to “focal” ablation with a catheter, but this would not have detained the systemic arrythmogenic mechanism and would not have cured the symptoms or prevented the potential onset of other foci of tachycardia. The association of frequent crises of atrial tachycardia and inappropriate sinus tachycardia plus sudden changes of blood pressure will guide the diagnosis and allow complete resolution of symptoms following resection of the pheochromocytoma.