致心律失常型右心室心肌病伴发心律失常性心肌病1例  

Arrhythmogenic right ventricular cardiomyopathy associated with arrhythmia-induced cardiomyopathy:A case report

作　　者：陈少敏[1] 孙超[1] 王新宇[1] 张媛[1] 刘书旺[1] CHEN Shao-min;SUN Chao;WANG Xin-yu;ZHANG Yuan;LIU Shu-wang(Department of Cardiology and Institute of Vascular Medicine,Peking University Third Hospital,Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides,Ministry of Health,Key Laboratory of Molecular Cardiovascular Science,Ministry of Education,Beijing Key Laboratory of Cardiovascular Receptors Research,Beijing 100191,China)

机构地区：[1]北京大学第三医院心内科、血管医学研究所,国家卫生健康委心血管分子生物学与调节肽重点实验室,分子心血管学教育部重点实验室,心血管受体研究北京市重点实验室,北京100191

出　　处：《北京大学学报（医学版）》2021年第5期1002-1006,共5页Journal of Peking University:Health Sciences

摘　　要：致心律失常型右心室心肌病(arrhythmogenic right ventricular cardiomyopathy,ARVC)是一种遗传性心肌病,以右心室心肌被纤维和脂肪组织替代为病理特征,约50%的患者双心室受累[1]。西方人群该病患病率约为1/5000~1/1000,临床比较少见。在该病发展的不同阶段,先后出现心律失常、右心室结构及功能异常以及全心衰竭等临床表现,是35岁以下人群心脏性猝死(sudden cardiac death,SCD)的重要原因之一[2]。该病的心律失常以室性心律失常为特征,但房性心律失常同样很多见,长时间的快速性房性心律失常可以导致心功能进一步恶化。本文报告1例北京大学第三医院收治的ARVC伴发房性心动过速,并导致心律失常性心肌病的病例。Arrhythmogenic right ventricular cardiomyopathy(ARVC)is a kind of inherited cardio-myopathy,which is characterized by fibro-fatty replacement of right ventricular myocardium,leading to ventricular arrhythmia.However,rapid atrial arrhythmias are also common,including atrial fibrillation,atrial flutter and atrial tachycardia.Long term rapid atrial arrhythmia can lead to further deterioration of cardiac function.This case is a 51-year-old male.He was admitted to Department of Cardiology,Peking University Third Hospital with palpitation and fatigue after exercise.Electrocardiogram showed incessant atrial tachycardia.Echocardiography revealed dilation of all his four chambers,especially the right ventricle,with the left ventricular ejection fraction of 40%and the right ventricular hypokinesis.Cardiac magnetic resonance imaging found that the right ventricle was significantly enlarged,and the right ventricular aneurysm had formed;the right ventricular ejection fraction was as low as 8%,and the left ventricular ejection fraction was 35%.The patients met the diagnostic criteria of ARVC,and both left and right ventricles were involved.His physical activities were restricted,and metoprolol,digoxin,spironolactone and ramipril were given.Rivaroxaban was also given because atrial tachycardia could cause left atrial thrombosis and embolism.His atrial tachycardia converted spontaneously to normal sinus rhythm after these treatments.Since the patient had severe right ventricular dysfunction,frequent premature ventricular beats and non-sustained ventricular tachycardia on Holter monitoring,indicating a high risk of sudden death,implantable cardioverter defibrillator(ICD)was implanted.After discharge from hospital,physical activity restriction and the above medicines were continued.As rapid atrial arrhythmia could lead to inappropriate ICD shocks,amiodarone was added to prevent the recurrence of atrial tachycardia,and also control ventricular arrhythmia.After 6 months,echocardiography was repeated and showed that the left ventricl

关 键 词：致心律失常型右心室心肌病 房性心律失常 心律失常性心肌病 

分 类 号：R541[医药卫生—心血管疾病]