心动过速终止后短暂心室复极异常和严重室性心律失常  

Abnormal ventricular repolarization and malignant ventricular arrhythmia leaded by tachycardia in short-term of tachycardia termination

作　　者：单其俊[1] 陈椿[1] 张晓宇[1] 徐东杰[1] 邹建刚[1] 陈明龙[1] 杨兵[1] 侯小峰[1] 曹克将[1] 

机构地区：[1]南京医科大学附属第一医院心脏科,210029

出　　处：《中华心律失常学杂志》2008年第5期348-352,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：江苏省政府“六大人才高峰”资助项目（07-B-014）

摘　　要：目的观察长时间心动过速终止后对心室复极和恶性室性心律失常发生的影响。方法3例长时间心动过速（9d～6个月）患者，两例为长时间发作室性心动过速（室速），其中1例为无休止性左心室特发性室速并诱发心动过速性心肌病；另1例为主动脉瓣换瓣术后5年发生束支折返性室速；第3例为持续性心房扑动伴心功能不良并因三度房室阻滞于10年前植入单腔起搏器。结果3例患者在心动过速时并无晕厥和恶性室性心律失常发生，而在心动过速间隙或射频导管消融终止后均出现QT间期延长和恶性心律失常，其中1例持续心房扑动合并心力衰竭的患者最后死于多脏器功能衰竭；另两例室速射频导管消融治疗后1周QT间期逐渐恢复正常，分别随访20和39个月无室速和晕厥发作。结论长时间心动过速后可导致短时间心室复极异常及恶性室性心律失常，应加强防范，防止发生心脏性猝死。Objective To observe the long-standing tachycardia effect on the ventricular repolariztion and malignant ventrieular arrhythmia events in short-term of taehycardia termination. Methods This observation included two patients with long-standing ventricnlar tachycardia（9 days - 6 months）and one with persistent atrial flutter. One patient had the incessant idiopathic left ventricular taehycardia induced cardiomyopathy. Another one got persistent bundle branch reentry tachycardia after 5 years of aortic valvular replacement. The third patient with persistent atrial flutter had implanted the VVI pacemaker for ten years due to complete atrioventricular block and developed heart failure in recent two years. Results There were no tosade de pointes and polymorphic ventricular tachyeardia or ventricular fibrillation episodes and syncope in these patients during tachycardia. But all patients experienced syncope episodes during intermitted tachycardia period or short after successful catheter ablation of tachycardia, and their electrocardiograms showed the QT prolongation and documented torsade de pointes and polymorphic ventrieular or ventrieular fibrillation. At last, the patient with atrial flutter and heart failure died from multiple organs function failures due to recurrent and long-duration ventricular fibrillation episodes. The QT interval became nearly normal after one week of successful catheter ablation of tachycardia in other two patients. They had no syncope and tachycardia episode in 20 and 39 month period of followup,respectively. Conclusion Long-standing tachycardia could lead to abnormal ventricular repolarization and malignant ventricular arrhythmia in short-term of tachycardia termination. Further understanding of this phenomenon is important for protecting against the sudden cardiac death in patients with long-standing tachycardia.

关 键 词：心动过速 心室复极 心脏性猝死 

分 类 号：R541.7[医药卫生—心血管疾病]