Barra Sérgio, Moreno Nuno, Providência Rui, Gonçalves Helena, Primo João José
Cardiology Department, Coimbra Hospital and University Centre, Coimbra, Portugal.
Rev Port Cardiol. 2013 Jun;32(6):523-9. doi: 10.1016/j.repc.2012.10.016. Epub 2013 Jun 6.
A 15-year-old girl was admitted to the cardiology outpatient clinic due to mild palpitations and documented incessant slow ventricular tachycardia (VT) with left bundle branch block (LBBB) pattern. The baseline electrocardiogram revealed first-degree atrioventricular block and intraventricular conduction defect. Transthoracic echocardiography showed prominent trabeculae and intertrabecular recesses suggesting left ventricular noncompaction (LVNC), which was confirmed by cardiac magnetic resonance imaging. During electrophysiological study, a sustained bundle branch reentrant VT with LBBB pattern and cycle length of 480 ms, similar to the clinical tachycardia, was easily and reproducibly inducible. As there was considerable risk of need for chronic ventricular pacing following right bundle ablation, no ablation was attempted and a cardioverter-defibrillator was implanted. To the best of our knowledge, no case reports of BBR-VT as the first manifestation of LVNC have been published. Furthermore, this is an extremely rare presentation of BBR-VT, which is usually a highly malignant arrhythmia.
一名15岁女孩因轻度心悸就诊于心脏病门诊，记录到持续的缓慢室性心动过速（VT），呈左束支传导阻滞（LBBB）图形。基线心电图显示一度房室传导阻滞和室内传导缺陷。经胸超声心动图显示突出的肌小梁和小梁间隐窝，提示左心室心肌致密化不全（LVNC），心脏磁共振成像证实了这一点。在电生理研究中，与临床心动过速相似的、呈LBBB图形且周长为480毫秒的持续性束支折返性室性心动过速很容易被诱发且可重复诱发。由于右束支消融后有相当大的需要慢性心室起搏的风险，未尝试消融，而是植入了心脏复律除颤器。据我们所知，尚无关于束支折返性室性心动过速作为左心室心肌致密化不全首发表现的病例报告。此外，这是束支折返性室性心动过速极为罕见的表现形式，它通常是一种高度恶性的心律失常。
