Cai N
Zhong Shan Hospital, Shanghai Medical University.
Zhonghua Xin Xue Guan Bing Za Zhi. 1991 Dec;19(6):359-60, 397.
Five patients, 4 male, 1 female with age ranging from 25 to 65 were included in the study. All the cases admitted into the hospital because of episodes of ventricular tachycardia (VT). Four associated with history of Adams-Stokes attacks. Their common manifestations are as followed: 1. Sustained LBBB VT associated with history of syncope and/or Adams-Stokes-Syndrome. 2. Inverted T waves in right precordial leads. 3. Positive ventricular late potential. 4. Relatively normal heart on physical examination and X-ray film. 5. Enlargement and dysfunction of right ventricle, 3 with a diverticulum-like bulging lesion at apex of right ventricle, proved by echocardiographic and nuclear angiocardiographic study. 6. Repeatedly induced VT during electrophysiological study. Our data suggest that arrhythmogenic right ventricular dysplasia (ARVD) should be suspected in patients with recurrent LBBB VT and relatively normal heart, especially, those with positive ventricular late potential. Right ventricle should be carefully investigated with echocardiography and nuclear angiocardiography to confirm the diagnosis. Four cases in the study were refractory to antiarrhythmic drug therapy and 2 of them were treated successfully with transcatheter electrical ablation, 1 with surgical intervention.
该研究纳入了5例患者,4例男性,1例女性,年龄在25至65岁之间。所有病例均因室性心动过速(VT)发作入院。其中4例伴有阿-斯综合征病史。其共同表现如下:1. 持续性左束支传导阻滞性室速,伴有晕厥和/或阿-斯综合征病史。2. 右胸前导联T波倒置。3. 心室晚电位阳性。4. 体格检查和X线片显示心脏相对正常。5. 右心室扩大和功能障碍,3例右心室尖部有憩室样膨出病变,经超声心动图和核素心血管造影证实。6. 电生理研究中反复诱发室速。我们的数据表明,对于复发性左束支传导阻滞性室速且心脏相对正常的患者,尤其是心室晚电位阳性的患者,应怀疑致心律失常性右心室发育不良(ARVD)。应通过超声心动图和核素心血管造影仔细检查右心室以确诊。该研究中的4例对抗心律失常药物治疗无效,其中2例经导管电消融治疗成功,1例接受了手术干预。