Kahl Béatrice Susanne, Marx Manfred, Gass Matthias, Wiedemann Dominik, Michel-Behnke Ina
Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Pediatric Heart Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, Vienna A-1090, Austria.
Division of Cardiac Surgery, Department of Surgery, Pediatric Heart Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, Vienna A-1090, Austria.
Eur Heart J Case Rep. 2024 Sep 17;8(10):ytae509. doi: 10.1093/ehjcr/ytae509. eCollection 2024 Oct.
Incessant tachycardias can severely impair cardiac function, which is known as tachycardia-induced cardiomyopathy (TIC). The cornerstone of successful therapy is heart rate control. Otherwise, heart failure requiring mechanical circulatory support (MCS) and ultimately heart transplantation may evolve. We report a case of successful weaning from MCS after severe TIC due to the very rarely incessant atypical atrioventricular nodal re-entrant tachycardia (aAVNRT) with subsequent successful radiofrequency ablation (RFA).
An 8-year-old girl was transferred to our unit with severely impaired cardiac function and went into circulatory collapse, including cardiopulmonary resuscitation. Stabilization was possible only by MCS, first by venoarterial extracorporeal membrane oxygenation, switched to long-term MCS (). However, pharmacological control of heart rate allowed myocardial recovery and finally the device was successfully explanted. As TIC was causative for the cardiomyopathy, the patient underwent invasive electrophysiological mapping and subsequent curative ablation of an aAVNRT.
This case report describes technical considerations of both the special electrophysiological aspects of this rare tachycardia and the weaning protocol from a pulsatile ventricular assist device in a young child who finally recovered from TIC. Pharmacological heart rate control delayed curative RFA until explantation of the MCS.
持续性心动过速可严重损害心脏功能，即所谓的心动过速性心肌病（TIC）。成功治疗的基石是控制心率。否则，可能会发展为需要机械循环支持（MCS）并最终进行心脏移植的心力衰竭。我们报告一例因极为罕见的持续性非典型房室结折返性心动过速（aAVNRT）导致严重TIC后成功撤离MCS并随后成功进行射频消融（RFA）的病例。
一名8岁女孩因心脏功能严重受损被转至我院，出现循环衰竭，包括心肺复苏。仅通过MCS才能实现稳定，首先是采用静脉-动脉体外膜肺氧合，之后转为长期MCS（）。然而，心率的药物控制使心肌得以恢复，最终成功移除了该装置。由于TIC是心肌病的病因，患者接受了有创电生理标测并随后对aAVNRT进行了根治性消融。
本病例报告描述了这种罕见心动过速特殊电生理方面的技术考量以及一名最终从TIC中康复的幼儿从搏动性心室辅助装置撤离的方案。药物性心率控制将根治性RFA推迟至MCS移除之后。
