Miki Tomonori, Shiraishi Hirokazu, Shirayama Takeshi, Matoba Satoaki
Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Prog Rehabil Med. 2020 Nov 17;5:20200028. doi: 10.2490/prm.20200028. eCollection 2020.
Recent reports on catheter ablation for premature ventricular complex (PVC) or ventricular tachycardia in the context of cardiomyopathy suggest that ablation can improve cardiac function and decrease the number of PVCs. However, reports on exercise tolerance after catheter ablation for PVC are few.
A 56-year-old woman consulted her primary care doctor presenting with palpitations and fatigue on exertion. Her left ventricular systolic function had been normalized with medications after a diagnosis of dilated cardiomyopathy 5 years previously. Electrocardiography showed sinus rhythm and ventricular bigeminy. Holter electrocardiography revealed a total of 34,867 PVCs. The highest number of consecutive PVCs recorded was three. In the cardiopulmonary exercise test, the peak oxygen consumption (VO) was markedly reduced to 14 ml/kg/min. The patient was referred to our hospital for catheter ablation because pharmacotherapy was ineffective. PVCs originated from the left ventricular outflow tract and were successfully eliminated by ablation at the non-coronary cusp of the aortic valve using three-dimensional activation mapping with a CARTO system. The patient's symptoms on exertion improved immediately after ablation. Postoperative Holter electrocardiography revealed that the number of PVCs had decreased to one per day. Peak VO had markedly improved to 22 ml/kg/min 2 months after catheter ablation therapy.
The elimination of frequent PVCs contributed to improved exercise tolerance.
近期有关心肌病患者室性早搏（PVC）或室性心动过速导管消融治疗的报告表明，消融可改善心脏功能并减少PVC数量。然而，关于PVC导管消融术后运动耐量的报告较少。
一名56岁女性因心悸和劳力性疲劳咨询其初级保健医生。5年前诊断为扩张型心肌病后，其左心室收缩功能已通过药物治疗恢复正常。心电图显示窦性心律和室性二联律。动态心电图显示共有34867次PVC。记录到的连续PVC最高次数为3次。在心肺运动试验中，峰值耗氧量（VO）显著降低至14 ml/kg/min。由于药物治疗无效，该患者被转诊至我院进行导管消融。PVC起源于左心室流出道，通过使用CARTO系统的三维激动标测在主动脉瓣无冠瓣处进行消融成功消除。消融术后患者的劳力性症状立即改善。术后动态心电图显示PVC数量已减少至每天1次。导管消融治疗2个月后，峰值VO显著改善至22 ml/kg/min。
消除频繁的PVC有助于提高运动耐量。
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