Lu B, Roberts B, Sadaniantz A
Division of Cardiology, Miriam Hospital, Brown University School of Medicine, Providence, RI 02906, USA.
J Am Soc Echocardiogr. 1997 Jan-Feb;10(1):88-92. doi: 10.1016/s0894-7317(97)80038-7.
We report a case of total pulse alternans in a patient with paroxysmal ectopic atrial tachycardia and echocardiographic findings obtained before and after radiofrequency catheter ablation (RFCA) that terminated the arrhythmia. The patient was a 27-year-old man with history of paroxysmal palpitations with worsening episodic dizziness, chest tightness, and dyspnea. Electrocardiography (ECG) showed atrial tachycardia at 160 to 170 beats/min while the simultaneous pulse was in the 80s beats/min. Echocardiogram showed that aortic and mitral valves opened with alternating excursions and outflow velocities. Furthermore, despite similar ventricular wall thickening during systole of consecutive cardiac cycles, there was alternating mitral valve opening during diastole of the same cycles, providing direct evidence that ineffective diastolic filling and mitral valve opening may play a role in the pathogenesis of pulse alternans. Repeat ECG and echocardiography after the successful RFCA showed normal sinus rhythm and normal opening excursion and the velocity across the aortic and mitral valves.
我们报告了一例阵发性异位房性心动过速患者出现完全性脉搏交替的病例，并展示了在射频导管消融（RFCA）终止心律失常前后获得的超声心动图检查结果。该患者为一名27岁男性，有阵发性心悸病史，伴有发作性头晕、胸闷和呼吸困难加重。心电图（ECG）显示心房率为160至170次/分钟，而同时脉搏为80多次/分钟。超声心动图显示主动脉瓣和二尖瓣以交替的幅度开放和流出速度。此外，尽管在连续心动周期的收缩期心室壁增厚相似，但在相同周期的舒张期二尖瓣开放存在交替，这提供了直接证据表明无效的舒张期充盈和二尖瓣开放可能在脉搏交替的发病机制中起作用。成功进行RFCA后复查心电图和超声心动图显示窦性心律正常，主动脉瓣和二尖瓣开放幅度及跨瓣速度正常。
