Simonenko Maria, Fedotov Petr, Babenko Alina, Karpenko Mikhail
Physiology Research and Blood Circulation Department, Cardiopulmonary Exercise Test SRL, Federal State Budgetary Institution, "V.A. Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation, 197341, Akkuratova street, 2, Saint-Petersburg, Russian Federation.
Heart Failure Research Department, Federal State Budgetary Institution "V.A. Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation, 197341, Akkuratova street, 2, Saint-Petersburg, Russian Federation.
Eur Heart J Case Rep. 2019 Jun 1;3(2). doi: 10.1093/ehjcr/ytz030.
There is a lack of information about a mixed type of amiodarone-induced thyrotoxicosis (AIT) after heart transplantation (HTx) with no amiodarone treatment in almost 1 year. Frequent ventricular extrasystoles (VES) associated with a mixed type of AIT can often be treated using thiamazole and prednisolone, without the need for specific antiarrhythmic treatment.
We present a clinical case of a 65-year-old heart transplanted male patient with frequent VES associated with mixed type of AIT. Recipient had managed with amiodarone prior to HTx but there were no indications for it after the surgery. One year after antiarrhythmic treatment was discontinued, monomorphic VES (total amount: 27 472/day) were diagnosed. In addition, our investigation revealed that thyrotoxicosis developed. Prednisolone and thiamazole were added to the treatment with positive outcomes. The antithyroid treatment had been discontinued after 9 months and results of the 24-h Holter electrocardiogram monitoring showed only two VES/24 h.
The case highlights the association of amiodarone, thyroid disorders, and VES. In mixed type AIT or if diagnosis is uncertain, it is reasonable to use mixed therapy. Next is to decide whether you need special treatment for VES. There was no evidence of ventricular tachycardia. Thyroid function tests remained normal off antithyroid medications and the total amount of VES significantly decreased. There were no indications for any antiarrhythmic treatment or ablation.
对于心脏移植（HTx）后近1年未使用胺碘酮治疗却发生混合型胺碘酮所致甲状腺毒症（AIT）的情况，目前缺乏相关信息。与混合型AIT相关的频发室性早搏（VES）通常可采用甲巯咪唑和泼尼松龙治疗，无需进行特定的抗心律失常治疗。
我们报告一例65岁心脏移植男性患者，患有与混合型AIT相关的频发VES。受体在HTx前曾使用胺碘酮治疗，但术后无使用指征。在停用抗心律失常治疗1年后，诊断出单形性VES（总量：27472次/天）。此外，我们的调查显示发生了甲状腺毒症。治疗中加用了泼尼松龙和甲巯咪唑，取得了良好效果。9个月后停用抗甲状腺治疗，24小时动态心电图监测结果显示仅2次VES/24小时。
该病例突出了胺碘酮、甲状腺疾病和VES之间的关联。在混合型AIT或诊断不确定时，采用联合治疗是合理的。接下来是决定是否需要对VES进行特殊治疗。没有室性心动过速的证据。停用抗甲状腺药物后甲状腺功能检查仍正常，VES总量显著减少。没有任何抗心律失常治疗或消融的指征。
