背景:我们报道了一例由频繁的室性早搏(PVC)和随后的室性早搏(VEBs)引起的心肌病。很少报道VEBs在代偿性停顿中诱发心肌病的PVC。此外,该病例表现出更容易诱发心肌病的PVCs的许多特征,比如原产地,耦合间隔越长,QRS波伴有P波。
方法:一名53岁左心室(LV)功能障碍的男性患者,胸部窘迫,和呼吸困难3年。Holter显示PVC的室性心律负担很高,并且还有另一种广泛的QRS模式(24小时内总搏动为96,562次,宽QRS搏动为87,330次)。左心室射血分数下降到34%,左心室,左右心房都扩张了.
方法:他被诊断为PVC诱发的心肌病。
方法:患者经历了心内电生理检查,显示在代偿性停顿中频繁的PVC和VEBs。进行PVCS的激活标测和消融。
结果:消融后PVC和VEBs消失。手术后2天,LV射血分数增加至46%。右心房和左心房的直径也显著减小。
结论:VEBs可能发生在PVCs代偿性停顿期间。具有VEB的PVC可导致心室节律和LV功能障碍的高负担。消融PVC还可以消除VEB并改善LV功能。
BACKGROUND: We reported a
case with cardiomyopathy induced by frequent premature ventricular contractions (PVCs) and followed ventricular escape beats (VEBs). PVCs with VEBs in the compensatory pause which induced cardiomyopathy is rarely reported. Also, the
case exhibited many characteristics of PVCs which were more likely to induce cardiomyopathy, like the location of origin, the longer coupling interval, and the QRS wave companied with the P wave.
METHODS: A 53-year-old man with left ventricular (LV) dysfunction presented with palpation, chest distress, and dyspnea for 3 years. Holter revealed a high burden of ventricular rhythm of PVCs and another wide QRS patterns (96,562 total beats with 87,330 wide QRS beats in 24 hours). The LV ejection fraction decreased to 34% and the left ventricle, right and left atria all dilated.
METHODS: He was diagnosed with PVC-induced cardiomyopathy.
METHODS: The patient experienced intracardiac electrophysiological examination which revealed frequent PVCs followed by VEBs in the compensatory pause. Activation mapping of the PVCS and ablation were performed.
RESULTS: PVCs and VEBs disappeared after ablation. The LV ejection fraction increased to 46% at 2 days after the procedure. The diameters of the right and left atria were also significantly reduced.
CONCLUSIONS: VEBs may occur during the compensatory pause of PVCs. PVCs with VEBs can lead to a high burden of ventricular rhythm and LV dysfunction. Ablation of the PVCs can also eliminate VEBs and improve the LV function.