'Bundle branch reentrant' ventrikulska tahikardija – Ventrikulska tahikardija koja kruži preko grana – Prikaz dva slučaja

Autor: Vedran Velagić, Davor Puljević
Jazyk: angličtina
Rok vydání: 2011
Předmět:
Zdroj: Cardiologia Croatica
Volume 6
Issue 12
ISSN: 1848-5448
1848-543X
Popis: «Bundle branch reentrant» ventrikulska tahikardija (BBRVT) je rjeđi oblik dugotrajne monomorfne ventrikulske tahikardije (VT) koja se dominantno javlja u bolesnika s teškom, prvenstveno dilatativnom kardiomiopatijom. Budući se radi o VT brze frekvencije koja rezultira hemodinamskom nestabilnošću, presinkopa i sinkopa česti su prezentirajući simptomi. U bazičnom EKG zapisu u bolesnika s ovom aritmijom nalazimo intraventrikulske smetnje provođenja po tipu bloka lijeve grane (LBBB), a često i PQ prolongaciju. Isto tako, VT je najčešće LBBB morfologije, frekvencije preko 200/min, a morfologija QRS-a se ne razlikuje značajno u sinusnom ritmu i samoj aritmiji. Navedene karakteristike bolesnika i same tahikardije trebaju nas navesti da pomislimo na ovu posebnu vrstu tahikardije. Definitivna dijagnoza postavlja se elektrofiziološkim ispitivanjem kojim dokazujemo da kružni mehanizam tahikardije koristi Hisov snop te lijevu i desnu granu provodnog sustava srca. Produžen HV interval kao marker usporenog provođenja kroz Hisov snop i distalnije dijelove provodnog sustava jedna je od glavnih karakteristika navedene tahikardije. Ablacija desne grane je u ovoj aritmiji kurativna. Najčešća komplikacija ablacije je totalni AV blok koji se javlja u 10-30% slučajeva što zahtjeva implantaciju trajnog elektrostimulatora srca. Zbog osnovne bolesti srca i mogućnosti i drugih tipova VT ovi bolesnici imaju i nakon uspješne ablacije indikaciju za implantaciju kardioverter-defibrilatora u svrhu primarne prevencije nagle srčane smrti. Ovdje prikazujemo dva recentna slučaja BBRVT.
Bundle branch reentrant ventricular tachycardia (BBRVT) is a rare form of long-term monomorphic ventricular tachycardia (VT), which predominantly occurs in patients with severe, primary dilated cardiomyopathy. Since this is a fast frequency VT resulting in hemodynamic instability, presyncope and syncope are common presenting symptoms. In the basic ECG in patients with this arrhythmia we find intraventricular disorders of conduction in type left bundle branch block (LBBB) and often PQ prolongation. Also, VT is usually of LBBB morphology, with heart rate over 200/min, while QRS morphology does not significantly differ in sinus rhythm and the arrhythmia itself. These characteristics of the patients and the tachycardia should make us consider of this special type of tachycardia. Definitive diagnosis is made by electrophysiological study to prove that a circular mechanism of tachycardia uses bundle of His and the left and right branch of the conducting system of the heart. Prolonged HV interval as a marker of slowed conduction through the bundle of His and more distal parts of the conducting system is one of the main characteristics of this tachycardia. The ablation of right bundle branch is curative in this arrhythmia. The most common complication of ablation is a total AV block that occurs in 10-30% of cases, which requires the implantation of permanent heart electrostimulator. Due to the basic disease of the heart and the possibility of other types of VTs, these patients show after successful ablation the indication for implantation of cardioverter-defibrillator for primary prevention of sudden cardiac death. Here we present two recent cases of BBRVT.
Databáze: OpenAIRE
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