PDF(Pubmed)
Abstract：
We present a unique case of an 80-year-old male who presented to our emergency department following cardiac defibrillation when he was found to be in polymorphic ventricular tachycardia (VT) after a syncopal event while at cardiac rehabilitation. He had known coronary artery disease and had a four-vessel coronary artery bypass graft (CABG) 20 years prior to presentation. He underwent left heart catheterization (LHC) two months prior to the syncopal event for worsening shortness of breath and the decision at that time was to proceed with medical management and intervene with redo-CABG if shortness of breath did not improve or progressively worsened. While admitted under our care after the polymorphic VT event, we faced the dilemma of whether to proceed with redo-CABG first since cardiac ischemia is a common cause of polymorphic VT or whether to insert an implantable cardioverter-defibrillator (ICD) before proceeding with redo-CABG. We present the current literature that addresses ICD implantation for secondary prevention and our approach to this complicated case.
摘要：
我们介绍了一个80岁男性的独特案例，该男性在心脏除颤后出现心脏复健时，在晕厥事件后被发现患有多形性室性心动过速（VT）时出现了心脏除颤。他患有冠状动脉疾病，并且在就诊前20年进行了四血管冠状动脉搭桥术（CABG）。在晕厥事件发生前两个月，他因呼吸急促恶化而接受了左心导管检查（LHC），当时的决定是继续进行医疗管理，如果呼吸急促没有改善或逐渐恶化，则进行重做CABG干预。在多态VT事件后接受我们的治疗时，由于心肌缺血是多形性室性心动过速的常见原因,我们面临的两难选择是先进行redo-CABG,还是先插入植入式心律转复除颤器(ICD)再进行redo-CABG.我们介绍了目前的文献，这些文献涉及ICD植入的二级预防以及我们对这种复杂病例的方法。
