Okajima Katsunori, Kiuchi Kunihiko, Yokoi Kiminobu, Teranishi Jin, Aoki Kosuke, Shimane Akira, Nakamura Yoshihide, Kimura Motoko, Horikawa Yoshio, Yoshida Masato, Maniwa Yoshimasa
Department of Cardiology, Himeji Cardiovascular Center, 520 Saisho-ko, Himeji, Hyogo Prefecture, Japan.
Department of Pediatrics, Kinki University Graduate School of Medicine, Japan.
J Arrhythm. 2016 Feb;32(1):62-6. doi: 10.1016/j.joa.2015.07.002. Epub 2015 Aug 30.
A 27-year-old woman with frequent implantable cardioverter defibrillator (ICD) shocks related to catecholaminergic polymorphic ventricular tachycardia (VT) experienced aborted sudden death due to incessant polymorphic VT despite the administration of beta-blockers, verapamil, and flecainide. Catheter ablation failed to suppress the polymorphic VT. Based on the temporary efficacy of the local anesthetic administered at the left and right cervical sympathetic nerves to suppress VT under an isoproterenol infusion, stepwise, bilateral thoracoscopic sympathectomy was performed. Postoperatively, no further VT or syncopal episodes were documented under ICD telemetry. Bilateral thoracoscopic sympathectomy may be an alternative for patients with drug-refractory catecholaminergic polymorphic VT.
一名27岁女性，因儿茶酚胺能多形性室性心动过速（VT）频繁接受植入式心脏复律除颤器（ICD）电击，尽管使用了β受体阻滞剂、维拉帕米和氟卡尼，但仍因持续性多形性VT发生猝死未遂。导管消融未能抑制多形性VT。基于在异丙肾上腺素输注下局部麻醉药注入左、右颈交感神经抑制VT的临时疗效，遂进行了逐步双侧胸腔镜交感神经切除术。术后，ICD遥测未记录到进一步的VT或晕厥发作。双侧胸腔镜交感神经切除术可能是药物难治性儿茶酚胺能多形性VT患者的一种替代治疗方法。
