Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; Department of Cardiology, University Hospital Geelong, Geelong, Vic, Australia.
Department of Cardiology, University Hospital Geelong, Geelong, Vic, Australia.
Heart Lung Circ. 2023 Aug;32(8):986-992. doi: 10.1016/j.hlc.2023.04.298. Epub 2023 May 19.
Polymorphic ventricular tachycardia (PMVT) is a highly lethal arrhythmia which is commonly caused by acute myocardial ischaemia. PMVT mediated by short-coupled ventricular ectopy patients with ischaemic heart disease but in the absence of acute ischaemia may relate to transient peri-infarct Purkinje fibre irritability and has been termed 'Angry Purkinje Syndrome'.
We present a case series of three patients with PMVT storm 3-5 days following coronary artery bypass graft surgery (CABG). In all three cases, recurrent episodes of PMVT were initiated by monomorphic ventricular ectopy with a short coupling interval. Acute coronary ischaemia was excluded in all three patients with a coronary angiogram and graft study. Two out of three of the patients commenced oral quinidine sulphate with subsequent rapid suppression of arrhythmia. Implantable cardiac defibrillators were implanted in all three patients and revealed no recurrence of PMVT following hospital discharge.
The Angry Purkinje Syndrome is a rare but important cause of ventricular tachycardia storm after CABG surgery and is mediated by short-coupled ventricular ectopy in the absence of acute myocardial ischaemia. This arrhythmia may be highly responsive to quinidine.
多形性室性心动过速（PMVT）是一种高度致命的心律失常，通常由急性心肌缺血引起。由短联律间期室性早搏引起的 PMVT 合并缺血性心脏病但无急性缺血患者可能与短暂的梗死周边浦肯野纤维易激惹有关，并被称为“愤怒浦肯野综合征”。
我们报告了 3 例冠状动脉旁路移植术后（CABG） 3-5 天发生 PMVT 风暴的患者。在所有 3 例患者中，反复出现的 PMVT 均由短联律间期的单形性室性早搏引发。所有 3 例患者均进行了冠状动脉造影和搭桥研究，排除了急性冠状动脉缺血。其中 2 例患者开始口服硫酸奎尼丁，随后心律失常迅速得到抑制。所有 3 例患者均植入了埋藏式心脏复律除颤器，出院后均未再出现 PMVT 复发。
愤怒浦肯野综合征是 CABG 术后室性心动过速风暴的一种罕见但重要的原因，由短联律间期室性早搏引起，无急性心肌缺血。这种心律失常可能对奎尼丁高度敏感。
