心动过速终止后短暂心室复极异常和严重室性心律失常

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(9 d～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qr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.

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

Objective To observe the long-standing tschycardia effect on the ventricular repelaristion and malignant ventricular arrhythmia events in short-term of tachycardia termination. Methods This observa-tion included two patients with long-standing ventricular tachycardia(9 days～6 months)and one with persistent atrial flutter. One patient had the incessant idiopathic left ventricular tachycardia induced cardiomyopathy. An-other 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 atrioventric-ular block and developed heart failure in recent two years. Results There were no tesode de peintes and poly-morphic ventricular tachycardia or ventricular fibrillation episodes and syncope in these patients during tachy-cardia. But all patients experienced syncope episodes during intermitted tachycardia period or short after suc-cessful catheter ablation of taehycardia,and their e]octrocardiograms showed the QT prolongation and documen-ted torsade de pointes and polymorphic ventricular or ventricular fibrillation. At last,the patient with atrial flut-ter and heart failure died from multiple organs function failures due to recurrent and long-duration ventricular fi-brillation episodes. The QT interval became nearly normal after one week of successful catheter ablation of tach-ycardia in other two patients. They had no syncope and tachycardia episode in 20 and 39 month period of follow-up,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 phenom-enon is important for protecting against the sudden cardiac death in patients with long-standing tachycardia.