Kaufmann Michael R, McKillop Matthew S, Burkart Thomas A, Panna Mark, Conti Jamie B, Miles William M
Tex Heart Inst J. 2018 Feb 1;45(1):39-41. doi: 10.14503/THIJ-16-6162. eCollection 2018 Feb.
Direct-current cardioversion is an important means of managing arrhythmias. During treatment, carefully synchronizing energy delivery to the QRS complex is necessary to avoid ventricular fibrillation caused by a shock during the vulnerable period of ventricular repolarization, that is, a shock on the T wave. The presence of an accessory pathway and ventricular preexcitation can lead to difficulty in distinguishing the QRS complex from the T wave because of bizarre, wide, irregular QRS complexes and prominent repolarization. We present the cases of 2 patients who had iatrogenic ventricular fibrillation from inappropriate T-wave synchronization during direct-current cardioversion of preexcited atrial fibrillation. Our experience shows that rapidly recognizing the iatrogenic cause of VF and immediate treatment with unsynchronized defibrillation can prevent adverse clinical outcomes.
直流电复律是治疗心律失常的重要手段。治疗期间，必须仔细将能量释放与QRS波群同步，以避免在心室复极的易损期因电击引发心室颤动，即T波上的电击。旁路和心室预激的存在可导致QRS波群与T波难以区分，因为QRS波群形态怪异、宽大、不规则且复极明显。我们报告了2例在预激性心房颤动直流电复律过程中因不适当的T波同步而发生医源性心室颤动的患者病例。我们的经验表明，迅速识别室颤的医源性原因并立即进行非同步除颤治疗可预防不良临床后果。
