Nakagawa Eiichiro, Takagi Masahiko, Tatsumi Hiroaki, Yoshiyama Minoru
Department of Internal Medicine and Cardiology, Osaka City University Medical School, Osaka, Japan.
Circ J. 2008 Jun;72(6):1025-9. doi: 10.1253/circj.72.1025.
The case of a 41-year-old man with Brugada syndrome (BS) who suffered electrical storms (ES) of ventricular fibrillation (VF) is presented. Although intravenous infusion of isoproterenol (ISP) suppressed the VF occurrence, he consistently experienced recurrence of VF following discontinuation of ISP infusion. Quinidine and cilostazol were ineffective. An analysis of VF episodes on electrocardiogram monitoring revealed that the QRS morphology of the first beat of all VF episodes was identical to that of premature ventricular complexes (PVCs) with a left bundle branch-block morphology and inferior axis, which occurred repetitively before the episodes of VF and were recorded throughout the day. In addition, stored electrograms from the implantable cardioverter defibrillator showed that the first beat of all VF episodes had the same morphology. On electrophysiological study, the VF-triggering PVC was found to originate from the posterior portion of the right ventricular outflow tract area and their elimination, which was achieved with radiofrequency catheter ablation (RFCA), resulted in the suppression of ES. Although several other PVCs were still observed, the patient has been free of VF during the 29-month follow-up period. This case indicates that RFCA of VF-triggering PVCs may be useful in the treatment of drug-resistant ES in patients with BS.
本文报告了一例41岁患有Brugada综合征（BS）的男性患者，该患者发生了室颤（VF）电风暴（ES）。尽管静脉输注异丙肾上腺素（ISP）可抑制VF的发生，但在停止输注ISP后，他仍持续出现VF复发。奎尼丁和西洛他唑均无效。通过对心电图监测的VF发作进行分析发现，所有VF发作的第一跳QRS形态与左束支传导阻滞形态且电轴下偏的室性早搏（PVC）相同，这些PVC在VF发作前反复出现且全天都有记录。此外，植入式心律转复除颤器存储的心电图显示，所有VF发作的第一跳形态相同。在电生理研究中，发现引发VF的PVC起源于右心室流出道区域的后部，通过射频导管消融（RFCA）消除这些PVC后，ES得到了抑制。尽管仍观察到其他几个PVC，但在29个月的随访期内，患者未再发生VF。该病例表明，对引发VF的PVC进行RFCA可能有助于治疗BS患者的耐药性ES。
