双向性室性心动过速5例分析  

The analysis of 5 cases with bidirectional ventricular tachycardia

作　　者：廉湘琳 秦巧云[1] 王一萌[1] 冯义静[1] 陈琼[1] 王亚青[1] 张路明 孙汝平[1] 王焕霞[1] 徐金义[1] Lian xianglin;Qin qiaoyun;Wang yimeng;Feng yijing;Chen qiong;Wang yaqing;Zhang luming;Sun ruping;Wang huanxia;Xu jinyi(Department of Cardiac and Pulmonary Function,Henan Provincial People's Hospital,Zhengzhou,450003,China)

机构地区：[1]河南省人民医院,450003

出　　处：《临床心电学杂志》2023年第2期109-114,118,共7页Journal of Clinical Electrocardiology

摘　　要：目的回顾性分析5例双向性室性心动过速(Bidirectional Ventricular Tachycardia,BVT)患者的心电图和临床特征,提高临床对BVT机制和典型特征的认识。方法收集河南省人民医院2018年10月至2022年3月资料完整的BVT患者5例,分析其临床资料及心电图特征。结果男4例,女1例;年龄27~68岁,平均48.4岁;地高辛中毒2例,免疫抑制剂相关心肌炎2例,低血钾1例;死亡3例、恢复窦律1例,转为无休止性室速1例;5例均节律匀齐,胸导联呈右束支阻滞图型2例、左右束支阻滞图型交替出现2例、左束支阻滞图型1例;肢体导联QRS波呈两种形态交替尤为明显;电轴表现为左偏右偏交替4例,左偏不偏交替1例。结论①双向性室速病情凶险,地高辛中毒和低血钾是BVT常见原因,ICIs相关心肌炎需引起临床重视;②心电图表现为两种形态的QRS波有规律交替出现,节律整齐,胸导联呈单一束支阻滞图型或左右束支阻滞图型交替,电轴极向改变。Objective To analysis the electrocardiography and clinical characteristics of 5 cases with bidirectional ventricular tachycardia,and to improve clinicians'understanding of the causes and typical clinical features.Methods We carried on a retrospective study involving 5 of BVT in our hospital from October 2018 to March 2022,and analyzed the electrocardiography and clinical characteristics.Results Four males and 1 female were admitted;the average age was 48.4 years(27~68 years old).Two cases had digitalis intoxication,2 cases had immne-checkpoint inhibitors(ICIs)related myocarditis,and 1 case with hypokalemia.Sinus rhythm was recovered in 2 cases,and a patients was converted to incessant ventricular tachycardia.There were 3 death patients.Electrocardiogram showed in precordial leads,2 cases with right bundle branch block pattern,2 cases with right and left bundle branch block pattern alternating on a beat to beat,and 1 case had left bundle branch block pattern,4 cases had left-and-right axis deviation,and 5 cases had regular rhythm.Conclusions BVT was dangerous,the causes of BVT were digoxin intoxication,immne-checkpoint inhibitors(ICIs)related myocarditis(PD-1 inhibitors relate myocarditis)and hypokalemia.The electrocardiogram showed that two QRS morphologies alternate on a beat-to-beat,with regular rhythm,with bundle branch block or right and left bundle branch block pattern alternating in precordial leads,and with left-and-right axis deviation.

关 键 词：双向性室性心动过速 心电图 地高辛中毒 低血钾 

分 类 号：R541.7[医药卫生—心血管疾病] R540.41[医药卫生—内科学]