Shirai Yasuhiro, Goya Masahiko, Ohno Seiko, Horie Minoru, Doi Shozaburo, Isobe Mitsuaki, Hirao Kenzo
Heart Rhythm Center, Tokyo Medical and Dental University Hospital, Tokyo, Japan.
Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan.
Pacing Clin Electrophysiol. 2017 May;40(5):600-604. doi: 10.1111/pace.13006. Epub 2017 Feb 14.
We report on a patient diagnosed with catechoaminergic polymorphic ventricular tachycardia (CPVT) who underwent catheter ablation of ventricular premature contractions (VPCs) induced by epinephrine. VPCs were classified roughly into three types. Type 1 and Type 2 VPCs (right bundle branch block [RBBB] configuration and inferior axis) were eliminated by radiofrequency applications at the left aortic sinus of Valsalva and the anterolateral papillary muscle (APM), respectively. Although no spontaneous VPCs were seen after the elimination of Type 1 and 2 VPCs, pacing resulting in capture at the APM induced Type 3 VPC (RBBB configuration and superior axis) reproducibly. The electrophysiological findings observed in our representative case have important implications both for understanding the pathophysiology of CPVT and for considering therapeutic strategies.
我们报告了一例被诊断为儿茶酚胺能多形性室性心动过速（CPVT）的患者，该患者接受了由肾上腺素诱发的室性早搏（VPC）的导管消融治疗。VPC大致分为三种类型。1型和2型VPC（右束支传导阻滞[RBBB]形态和下轴）分别通过在主动脉窦左窦和前外侧乳头肌（APM）处进行射频消融得以消除。尽管在消除1型和2型VPC后未观察到自发性VPC，但在APM处起搏导致夺获可重复性地诱发3型VPC（RBBB形态和上轴）。我们代表性病例中观察到的电生理结果对于理解CPVT的病理生理学以及考虑治疗策略均具有重要意义。
