Waldmann Victor, Marijon Eloi, Combes Nicolas
Cardiology Department, European Georges Pompidou Hospital, Paris, France.
Paris Descartes University, Paris, France.
Pacing Clin Electrophysiol. 2018 Apr;41(4):422-424. doi: 10.1111/pace.13140. Epub 2017 Jul 12.
We present a case of sudden cardiac arrest 7 hours after radiofrequency ablation of the atrioventricular junction for symptomatic permanent atrial fibrillation unresponsive to medical therapy. The Holter monitoring revealed a progressive increasing of QT interval after the procedure, highlighting the repolarization instability after acute changes in heart rates associated with modification of ventricular activation, leading to occurrence of short coupling interval ventricular extra beats and finally to a "torsade de pointes." This illustration underlines the need to program a relatively rapid ventricular rate first weeks after junction ablation, especially in case of rapid ventricular rate prior to the procedure, as well as the role of continuous ECG and QT interval monitoring during hospital stay.
我们报告一例因症状性永久性心房颤动接受房室结射频消融术，术后7小时发生心脏骤停的病例，该患者对药物治疗无效。动态心电图监测显示术后QT间期逐渐延长，突出了与心室激动改变相关的心率急性变化后复极不稳定，导致短联律间期室性早搏的发生，最终发展为“尖端扭转型室速”。此病例强调了在房室结消融术后最初几周设定相对较快心室率的必要性，尤其是术前心室率较快的情况，以及住院期间持续心电图和QT间期监测的作用。
