Laflamme Emilie, Philippon François, O'Connor Kim, Sarrazin Jean-François, Auffret Vincent, Chauvette Vincent, Dubois Michelle, Voisine Pierre, Bergeron Sébastien, Sénéchal Mario
Department of Cardiology.
Research Center.
Int Med Case Rep J. 2018 May 22;11:121-124. doi: 10.2147/IMCRJ.S150858. eCollection 2018.
Guidelines for cardiac resynchronization therapy (CRT) have been established, but there may be a subgroup of patients not identified in these guidelines who may benefit from this therapy. We report a patient with a dynamic left ventricular dyssynchrony and severe mitral regurgitation caused by exercise successfully treated with CRT. Exercise testing should be considered in patients with left ventricular ejection fraction <35% and QRS <130 ms with severe heart failure symptoms that are unexplained by rest echocardiography evaluation in order to rule out ischemia and/or dynamic left ventricular dyssynchrony. In the presence of exercise-induced left ventricular bundle branch block, the implantation of CRT should be contemplated.
心脏再同步治疗（CRT）的指南已经制定，但可能存在一些未在这些指南中被识别出来的患者亚组，他们可能从这种治疗中获益。我们报告了一例因运动导致动态左心室不同步和严重二尖瓣反流的患者，经CRT成功治疗。对于左心室射血分数<35%且QRS<130毫秒、伴有严重心力衰竭症状且静息超声心动图评估无法解释的患者，应考虑进行运动测试，以排除缺血和/或动态左心室不同步。如果存在运动诱发的左心室束支传导阻滞，则应考虑植入CRT。
