以电风暴为初发表现的冠状动脉粥样硬化性心脏病

Electrical storm as the initial manifestation of coronary artery disease

目的报告以电风暴为初发表现的冠心病。方法对反复晕厥或心脏骤停发作的患者行12导联动态心电图检查和冠状动脉造影。结果3例男性患者,年龄40,51和39岁。2例反复发生晕厥,动态心电图示室性心动过速(室速)/心室颤动(室颤)风暴;1例运动时室速/室颤。3例血管造影均发现冠状动脉狭窄90%以上,心电图U波明显,晨起或运动时一过性缺血型ST-T改变,室性早搏先于ST-T改变出现。以QRS波形态定位,电风暴起源与罪犯血管的供血区域一致。植入支架解除狭窄后,电风暴与ST-T改变消失,症状缓解。随访8,32个月和7年,未见电风暴发作,1例植入ICD,7年仅有1次不恰当电击。结论冠心病可以电风暴为初发表现。植入冠状动脉支架解除狭窄,消除缺血性电风暴的病理基础,可有效防治心脏性猝死。

Objective To report the electrical storm（ES）as the initial manifestation of coronary artery diseases （CAD）. Methods Twelve-lead Holter recording and coronary angiography were performed in patients with repetitive syncope and/or cardiac arrest. Results Three male patients aged at 40, 51, and 39 years old separately were hospitalized. In 2 patients with repetitive syncope attacks, multiple episodes of ventricular tachycardia（VT） and/or ventricular fibrillation （VF）were documented during elevation or depression of ST segment by Holter recording. One patient with frequent palpitation developed VT/VF during exercise testing. Coronary angiography revealed severe coronary stenosis in all of them. A remarkable U wave and frequent ventricular pre- mature beats were noticed before ST-T changes. ES origin was localized to papillary muscle region by using QRS morphology criterium and was in accordance with the supplement of culprit vessel. Symptom, ST-T changes and ES disappeared after coronary stenting. During 8, 32-month and 7-year follow-up, ES was not documented, only one appropriated shock occurred in the patient with implantable defibrillator for 7 years. Conclusion ES may present as the first manifestation of CAD. Coronary stenting prevents ES and sudden cardiac death.