主动脉瓣置换术后交替性宽QRS波心动过速

Darden Douglas, Eskander Michael, Feld Gregory K

Division of Cardiology, Department of Medicine, Cardiovascular Institute, University of California San Diego, United States.

Indian Pacing Electrophysiol J. 2021 May-Jun;21(3):191-195. doi: 10.1016/j.ipej.2021.02.001. Epub 2021 Feb 6.

A 51-year-old male developed recurrent episodes of palpitations and pre-syncope after surgical aortic valve replacement. Electrocardiograms after surgery revealed a wide complex tachycardia with alternating left bundle branch and right bundle branch block morphologies. An electrophysiology study (EPS) demonstrated typical bundle branch reentry ventricular tachycardia (BBRVT) treated successfully with right bundle ablation. We demonstrate the key diagnostic features of BBRVT on EPS, describe the circuit of BBRVT with explanation of the HV pseudointerval, and highlight the association of BBRVT and valve replacement.

一名51岁男性在接受主动脉瓣置换手术后出现反复发作的心悸和晕厥前症状。术后心电图显示宽QRS波心动过速，伴有交替的左束支传导阻滞和右束支传导阻滞形态。电生理研究（EPS）证实为典型的束支折返性室性心动过速（BBRVT），经右束支消融成功治疗。我们展示了EPS上BBRVT的关键诊断特征，描述了BBRVT的折返环路并解释了HV伪间期，强调了BBRVT与瓣膜置换的关联。