[SCD-FORUM] 81C 病历：男 现年29岁. 宁 朱

[SCD Symposium]

病历：男 现年29岁
8岁感冒后出现早搏诊断为病毒性心肌炎；此后早搏 
一直存在，并有右室大。
19岁第一次室速发作，持续时间3分钟后自行恢复，伴 
随症状有黑蒙。之后两三年一直无发作。
     21岁第二次发作，持续时间长达2~3小时，开始无 
明显症状，两小时后心慌，虚汗，随即昏厥几分钟， 
后静脉注射心律平转律。此后曾口服心律平但无效。
22~23岁期间曾于大连医科大学附属一院杨延宗教授处 
实施两次射频消融手术，均因诱发不成功而失败。第 
二次手术同时实施了心内膜活检证明为心肌病。
23~26岁期间未用药，室速间歇发作，每次几秒钟至几 
十分钟不等，均可自行恢复或去医院静脉注射心律平 
几分钟后即可恢复。深夜至凌晨发作较频繁。在这几 
年中整体规律为某一时间段集中发作（两次在冬 
季），此后可自行稳定几个月或更长时间。作为大学 
生，研究生患者喜好长跑，打球等剧烈运动，而运动 
中从无发作，至今患者的任何体力活动不受限制。
27岁即2004年口服心律平预防有效，心律平150mg bid　或 
tid。服用1~2个月停药后可稳定0.5~1.5年。
去年至今一直口服心律平无法停药，停药则发作频 
繁。目前为早200mg，晚150mg，低于此剂量即会发作。

     对这位患者目前的情况有何治疗建议？
宁 朱 <dyeyxnk在yahoo.com.cn>

-----------------

Case: Male, 29yrs

Illness history: Viral myocarditis was diagnosed based on premature  
ventricular contractions (PVCs) at age 8 after an influenza attack.  
Since then, PVBs never disappeared and right ventricle enlargement  
had been noticed.

ECG revealed VT lasting 3 minutes at age 19, accompanied with  
faintness. After 2-3 years, no VT reoccurred.

The second VT episode was recorded at age 21 lasting 2-3 hrs  
accompanied with syncope. Intravenous propafenon worked. Oral  
administration of propafenon could not prevent the patient from VT  
attack.

RFCA for VT had been delivered twice at age 22~23 by Pro. Yang at the  
first affiliated Hospital of Dalian medical university. During RFCA,  
VT could not be induced and cardiomyopathy was diagnosed by  
endocardiac biopsy.


VTs occurred intermediately lasting several seconds to a few minutes.  
VT restored to sinuous rhythm either spontaneously or by intravenous  
propafenon administration. VT usually occurred at midnight or early  
morning. At the following years, Sometimes VT occurred quite often  
during a certain period (for example: twice attacks in Winter), and  
then no occurrence for several months or even longer time. The  
patient enjoys doing exercise. No VT attacked during exercise. No  
restriction to exercise.

Since 27 yrs old (2004), propafenon has been administrated in the  
doses of 150mg bid or tid. Drug quitted after 1-2 months  
administrations, keeping no VT attack for 0.5-1.5 yrs.
Since last year, the drug cannot be quitted, otherwise VT reoccurred.  
So far, the doses of the drug are 200mg at early morning and 150mg at  
night. Lower dosages may not prevent the VTs.

Any suggestion about the treatment?

Zhu <dyeyxnk在yahoo.com.cn>.

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee