An unusual but reversible cause of ventricular fibrillation

A 61-year-old woman was admitted with general malaise, chest pain and
breathlessness. During her inpatient stay she sustained a ventricular fibrillation (VF)
arrest which was successfully terminated with direct current cardioversion. Cardiac
investigations revealed poor left ventricular systolic function but unequivocally
normal coronary arteries. During the course of her admission a macular rash
developed and following investigations including a renal biopsy, a new diagnosis of
systemic lupus erythematosus (SLE) and related myocarditis was reached. First
presentation of lupus with myocarditis and VF is uncommon, however reaching the
correct diagnosis is important as due to the reversible nature of the condition and
improvement in left ventricular systolic function with medical therapy, an implantable
cardioverter defibrillator (ICD) might not be appropriate. Our case report
demonstrates the importance of screening for reversible conditions when considering
ICD therapy for secondary prevention of malignant arrhythmias.