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一名心房颤动患者的宽QRS波心动过速：病例报告及诊断方法

Wide QRS tachycardia in a patient with atrial fibrillation: a case report and approach to diagnosis.

作者信息

Shaikh Mohammad, Golzarian Hafez, Hakim Fayaz A

机构信息

Internal Medicine Residency Program, BonSecours Mercy Health-St. Rita's Medical Center, 730 West Market Street, 2K Tower, Lima, OH 45801, USA.

Division of Cardiovascular Diseases, Heart Rhythm Services, St. Rita's Medical Center, Lima, OH 45801, USA.

出版信息

Eur Heart J Case Rep. 2024 Jul 15;8(8):ytae328. doi: 10.1093/ehjcr/ytae328. eCollection 2024 Aug.

DOI:10.1093/ehjcr/ytae328
PMID:39104514
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11299015/
Abstract

BACKGROUND

Wide QRS complex (QRS) tachycardia in patients with atrial fibrillation (AF) or atrial flutter treated with antiarrhythmic drugs can occur for a variety of reasons and needs careful evaluation for appropriate management of the patient.

CASE SUMMARY

We report a case of wide QRS complex tachycardia in a patient with AF treated with Flecainide who received multiple external cardioversion attempts for a presumed diagnosis of ventricular tachycardia. Intravenous Diltiazem and an oral beta-blocker led to the resolution of wide QRS complex tachycardia.

DISCUSSION

Wide QRS tachycardia due to pro-arrhythmic effect or rate-dependency phenomenon of antiarrhythmic agents should be included in the differentials. In this brief report, we discuss the differential diagnosis and outline a practical approach for acute and long-term management of these patients.

摘要

背景

房颤（AF）或房扑患者在使用抗心律失常药物治疗时出现宽QRS波群（QRS）心动过速的原因多种多样，需要仔细评估以便对患者进行恰当管理。

病例摘要

我们报告1例房颤患者使用氟卡尼治疗时出现宽QRS波群心动过速，该患者因疑似室性心动过速接受了多次体外心脏复律尝试。静脉注射地尔硫䓬和口服β受体阻滞剂使宽QRS波群心动过速得到缓解。

讨论

抗心律失常药物的促心律失常作用或频率依赖性现象所致的宽QRS心动过速应列入鉴别诊断。在本简要报告中，我们讨论了鉴别诊断，并概述了对这些患者进行急性和长期管理的实用方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce8f/11299015/9662b67ff8fc/ytae328f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce8f/11299015/87d294fd0c6c/ytae328il2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce8f/11299015/d44802637b3d/ytae328f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce8f/11299015/f3ab22cfd42a/ytae328f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce8f/11299015/59b68705d21b/ytae328f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce8f/11299015/d3b08010322a/ytae328f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce8f/11299015/9662b67ff8fc/ytae328f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce8f/11299015/87d294fd0c6c/ytae328il2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce8f/11299015/d44802637b3d/ytae328f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce8f/11299015/f3ab22cfd42a/ytae328f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce8f/11299015/59b68705d21b/ytae328f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce8f/11299015/d3b08010322a/ytae328f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce8f/11299015/9662b67ff8fc/ytae328f5.jpg

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本文引用的文献

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2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC.
2020年欧洲心脏病学会（ESC）与欧洲心胸外科学会（EACTS）合作制定的心房颤动诊断和管理指南：欧洲心脏病学会（ESC）心房颤动诊断和管理特别工作组，由ESC欧洲心律协会（EHRA）特别贡献制定。
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Mechanism of flecainide's rate-dependent actions on action potential duration in canine atrial tissue.氟卡尼对犬心房组织动作电位时程的频率依赖性作用机制。
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Frequency-dependent effects of antiarrhythmic drugs on action potential duration and refractoriness of canine cardiac Purkinje fibers.抗心律失常药物对犬心脏浦肯野纤维动作电位时程和不应期的频率依赖性影响。
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Clinical course and outcome in class IC antiarrhythmic overdose.I类C型抗心律失常药物过量的临床过程及转归
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