Ouali Sana, Ben Halima Manel, Boudiche Selim, Gharbi Anissa, Nadim Khedher, Hakim Kaouthar, Ouarda Fatma, Mourali Mohamed Sami
Cardiology Department, La Rabta Hospital, Tunisia.
Cardiology Department, La Rabta Hospital, Tunisia.
Indian Pacing Electrophysiol J. 2018 Mar-Apr;18(2):76-79. doi: 10.1016/j.ipej.2017.10.008. Epub 2017 Nov 4.
A 04-year-old boy was referred to our institution with severe, progressive heart failure of 4-months duration associated with a persistent wide QRS tachycardia with left bundle branch block and severe left ventricular dysfunction. Because of incessant wide QRS tachycardia refractory to antiarrhythmic drugs, he was referred for electrophysiological study. The ECG was suggestive of VT arising from the right ventricle near the His area. Electrophysiological study revealed that origin of tachycardia was septum of the right ventricle, near His bundle, however the procedure was not successful and an inadvertent complete atrioventricular conduction block occurred. The same ventricular tachycardia recurred. A second procedure was performed with a retrograd aortic approach to map the left side of the interventricular septum. The earliest endocardial site for ablation was localized in the anterobasal region of left ventricle near His bundle. In this location, one radiofrequency pulse interrupted VT and rendered it not inducible. The echocardiographic evaluation showed partial reversal of left ventricular function in the first 3 months. The diagnosis was idiopathic parahisian left ventricular tachycardia leading to a tachycardia mediated cardiomyopathy, an extremely rare clinical picture in children.
一名4岁男孩因持续4个月的严重进行性心力衰竭被转诊至我院，伴有持续的宽QRS心动过速，呈左束支传导阻滞及严重左心室功能障碍。由于抗心律失常药物难以控制持续性宽QRS心动过速，他被转诊进行电生理研究。心电图提示室性心动过速起源于希氏区附近的右心室。电生理研究显示心动过速起源于右心室间隔，靠近希氏束，但手术未成功，且意外发生了完全性房室传导阻滞。同样的室性心动过速复发。采用逆行主动脉途径进行了第二次手术，以标测室间隔左侧。最早的内膜消融部位定位于左心室希氏束附近的前基底区域。在此位置，一个射频脉冲终止了室性心动过速且使其不能被诱发。超声心动图评估显示在最初3个月左心室功能有部分恢复。诊断为特发性希氏束旁左心室心动过速导致心动过速介导的心肌病，这在儿童中是极为罕见的临床表现。
