Điều trị điện sinh lý cấp cứu các trường hợp rối loạn nhịp

Điều trị điện sinh lý cấp cứu trường hợp rối loạn nhịp BS Tô Hưng Thuỵ Trung tâm Tim Mạch Huế Trường hợp • Bn Nguyễn Văn Y 48 tuổi • Vv: VT storm lần schock điện dù xylocain , Amiodaron IV • H/o: – Bệnh tim dãn QRS rộng có VT → CRT –D – Nhiều lần shock chuyển nhịp ( kiểm tra máy) – Nhiều lần nhập viện >5 lần/năm • Chuyển viện TT TM Huế HA 70/40 mmHg RBBB S@V6 neg inf leads Siêu âm tim Thăm dò ĐSL Điều trị RF Vị trí đích → nhịp xoang có block nhĩ thất thống qua Điện tâm đồ sau đốt Bệnh tim nhịp nhanh • The rate and duration of the tachycardia are the major determinants of the onset, progression, and reversibility of tachycardia-induced cardiomyopathy • Reversibility of the cardiomyopathy following treatment of the SVT or VT is an important characteristic of tachycardia-induced cardiomyopathy • Medi et al identified several variables predisposing to cardiomyopathy—an incessant tachycardia, male gender, a mean ventricular rate of 117 ± 21 bpm, and an origin of the tachycardia from the appendages or the pulmonary veins Bệnh tim nhịp nhanh • However, reversal may not occur or may not be complete in all cases Most of the available literature on improvement in LV function relates to the grossly observed LV contractility Microscopic abnormalities may reverse more slowly or not at all • An improvement in LV systolic function after the restoration of sinus rhythm after AF ablation over a 6month follow-up.1–5 This case is unique for the dramatic improvement in LV systolic function and symptoms of congestive heart failure 10% of total beats • high PVC burden may not impair LV function, whereas PVC-induced cardiomyopathy can be observed in patients with lower PVC frequencies, albeit at lower incidences Cut-off value • the majority of patients presenting with frequent PVCs had preserved LVEF → the PVC burden, although significant, is not the only factor contributing to impairment of LV systolic function • Baman suggested that a PVC burden of >26% had a sensitivity and specificity of 79% and 78%, respectively, in separating the patient populations with impaired versus preserved LV function • Chân thành cảm ơn lắng nghe quý vị