Lee S H, Cheng J J, Kuan P, Hung C R
Department of Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1997 Aug;60(2):117-23.
We present here, the case of a 22-year-old male suffering from persistent tachycardia for the past 3 years. His resting pulse rate was rarely below 100 beats/min, and it frequently increased to as high as 150 beats/min even after a minimal of activity. Associated symptoms included palpitation, chest tightness, dyspnea and presyncope, either during rest or with exercise. Propranolol and verapamil could not control the tachycardia. The application of radiofrequency energy to an area in the superior right atrium that demonstrated a discrete electrogram with earliest endocardial activation during tachycardia resulted in a decrease in sinus rate from 120 beats/min to 70 beats/min. Follow-up on Holter monitor, performed one month later, demonstrated an average heart rate of 84 beats/min (range 60-125). In exercise tolerance test, the patient exercised for 9 minutes, achieving a maximum heart rate of 140 beats/min. This patient remained asymptomatic without any antiarrhythmic drug during the 3-month follow-up period. Medical management in case of patients showing disabling inappropriate sinus tachycardia refractory, sinus node modification could be considered as an suitable alternative to complete atrioventricular junctional ablation.
我们在此呈现一名22岁男性的病例，该患者在过去3年中一直患有持续性心动过速。他静息心率很少低于100次/分钟，即使在极少活动后也经常升至高达150次/分钟。相关症状包括心悸、胸闷、呼吸困难和先兆晕厥，无论是在休息时还是运动时。普萘洛尔和维拉帕米无法控制心动过速。对心动过速期间显示离散电图且心内膜最早激动的右上心房区域施加射频能量，导致窦性心率从120次/分钟降至70次/分钟。一个月后进行的动态心电图监测随访显示平均心率为84次/分钟（范围60 - 125）。在运动耐量测试中，患者运动了9分钟，最高心率达到140次/分钟。在3个月的随访期内，该患者在未使用任何抗心律失常药物的情况下仍无症状。对于表现为难治性致残性不适当窦性心动过速的患者，药物治疗无效时，可考虑窦房结改良作为完全房室交界区消融的合适替代方法。
