Capulzini Lucio, Sarkozy Andrea, Semeraro Oscar, Paparella Gaetano, Chierchia Gian Battista, DE Asmundis Carlo, Roos Markus, Yazaki Yoshinao, Muller-Burri Andreas, Sorgente Antonio, Brugada Pedro
Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium.
Pacing Clin Electrophysiol. 2010 Mar;33(3):e32-5. doi: 10.1111/j.1540-8159.2009.02587.x. Epub 2009 Oct 10.
We present the case of a 49-year-old woman with atrioventricular nodal re-entrant tachycardia and a severe pectus excavatum. The patient underwent an electrophysiological study and fast pathway ablation. Fast pathway ablation was not done on purpose but accidentally, likely due to the abnormal position of the heart in the chest cavity in this patient suffering from severe pectus excavatum. Some hours after the ablation, the patient developed inappropriate sinus tachycardia (IST), complaining of dyspnea and fatigue. IST has been described as a complication of fast pathway ablation in 10% of the cases. In our case it was not possible to treat IST with beta-blockers due to an important lowering of the blood pressure. Digitalis, given as second choice, was not successful. Ivabradine-the specific sinus node If current inhibitors-was used to successfully lower the heart rate with immediate relief of symptoms. A 24-hour Holter, 10 days later, showed a complete control of the heart rate without any episode of IST. The patient was completely symptom free and able to undertake her normal daily activities without any discomfort. Our case confirms the potential use of ivabradine for indications other than coronary artery disease.
我们报告一例49岁患有房室结折返性心动过速且伴有严重漏斗胸的女性病例。该患者接受了电生理检查及快径消融术。快径消融并非有意为之，而是意外发生，可能是由于该患有严重漏斗胸的患者心脏在胸腔内位置异常所致。消融术后数小时，患者出现不适当窦性心动过速（IST），伴有呼吸困难和疲劳症状。IST被描述为快径消融术后10%病例的并发症。在我们的病例中，由于血压显著降低，无法使用β受体阻滞剂治疗IST。作为第二选择使用的洋地黄也未成功。伊伐布雷定——特异性窦房结If电流抑制剂——被用于成功降低心率，症状立即缓解。10天后的24小时动态心电图显示心率得到完全控制，未出现任何IST发作。患者完全无症状，能够正常进行日常活动而无任何不适。我们的病例证实了伊伐布雷定在冠状动脉疾病以外适应症的潜在用途。
