[AF-FORUM] 69S房颤和进行性系统硬化症. Dr. Rodriguez Martorell

[AF Symposium]

我想知道各位专家对该病例的意见
66岁女性，进行性系统硬化症（硬皮病）病史，2次发 
作症状性房颤进而电转复。2周后第三次发作时再予 
以电复律（直流同步200J）无效。我们决定尝试控制 
心室率。予以维拉帕米静注后口服240mg/日，并予华法 
令抗凝。超声报告：LA: 46 mm, LSVD: 20 mm, LVEF: 66%, IVS: 13  
mm, 左室后壁心包积液4mm。LVPW: 12 mm,二尖瓣、三尖瓣 
轻度返流。肺动脉高压征象，小动脉受累。肺动脉血 
流加速时间68ms。LV. E/A: 3.62, 伴GIII 舒张功能障碍.
既往史：支气管哮喘，甲状腺功能亢进症，高血压二 
期，治疗已予甲状腺素，伊纳普利，甲状腺Hùrthle细 
胞癌II期.
请问该患者处控制心室率和抗凝治疗外，还有什么建 
议吗？
    Dr. Francisco Rguez Martorell.
     古巴，哈瓦那

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69S AF and progressive systemic sclerosis. Dr. Rodriguez Martorell

I would appreciate it if the panel of experts could let me know their
criterion about this case:
This is a 66-year-old female patient with history of Progressive  
Systemic Sclerosis and 2 episodes of symptomatic PAF that reverted
with electric cardioversion (ECV). The third episode occurred two
weeks later without any response to the same procedure, with 3
synchronized ECV of 200 j. We decided to attempt ventricular rate
control with EV Verapamil and after that, oral therapy 240 mg a day,
associated to oral anticoagulation (OAC) with Warfarin. The
echocardiogram reports LA: 46 mm, LSVD: 20 mm, LVEF: 66%, IVS: 13 mm,
maintained global and segmentary systolic function, pericardial
effusion of 4 mm posterior to LV.
LVPW: 12 mm, tricuspid and mild mitral regurgitation signs moderated
by color Doppler. Signs of PHT with arteriolar component.
Pulmonary acceleration time: 68 ms. Severe alterations of compliance
of both ventricular cavities at the expense of the LV. E/A: 3.62,
compatible with GIII Diastolic Dysfunction.
Personal pathological background: Bronchial asthma, hyperthyroidism,
HBP Stage II.
Therapy with L-Thyroxin, Enalapril, HCT Stage II.
Do you suggest a therapeutic option other than decreasing VF and OAC?
I apologize for not having identifying myself previously.
Best regards,

    Dr. Francisco Rguez Martorell.
           Habana . Cuba.

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee