首页> 外文期刊>Journal of Cardiovascular Disease Research >Failure of a cardiac resynchronization therapy-defibrillator sensing lead to correctly detect a fatal arrhythmia because of a newly emerged intraventricular conduction abnormality induced by cardiac sarcoidosis
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Failure of a cardiac resynchronization therapy-defibrillator sensing lead to correctly detect a fatal arrhythmia because of a newly emerged intraventricular conduction abnormality induced by cardiac sarcoidosis

机译:由于心脏结节病引起的新出现的心室内传导异常,心脏再同步治疗-除颤器感测失败会导致正确检测致命的心律失常

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Here, we report the case of a 59-year-old man with cardiac sarcoidosis (CS) who experienced the failure of a cardiac resynchronization therapy-defibrillator (CRT-D) because the sensing lead failed to operate correctly. The sensing lead, which was inserted into the right ventricular outflow tract (RVOT), failed because of a newly emerged intraventricular conduction abnormality (IVCA) resulting from the progression of the CS). For determining the cause of the failure, an electrophysiological study was conducted with catheters placed to the right ventricle apex (RVA) and RVOT. The IVCA was not seen during rapid pacing at 180 bpm but was observed during rapid pacing at over 190 bpm; however, this phenomenon may also develop as a result of the restitution property of conduction velocity due to the relative ventricular refractory period, even in the absence of CS. A voltage map recorded by the CARTO mapping system revealed a markedly low voltage area between the RVA and RVOT. Therefore, we assumed the heart rate for the ventricular tachyarrhythmia was underestimated by the CRT-D sensing lead and had thereby led to its operation failure. An appropriate intervention was accomplished by inserting an additional sensing lead to the RVA, and the same phenomenon has not occurred to date. To our knowledge, no similar report has previously been published, and thus makes this case an extremely rare and didactic case.
机译:在此,我们报告了一名59岁的患有心脏结节病(CS)的人,该人由于感应导线无法正确操作而经历了心脏再同步治疗除颤器(CRT-D)的故障。插入右心室流出道(RVOT)的传感导线由于CS的进展导致新出现的心室内传导异常(IVCA)而失败。为了确定失败的原因,将导管放置在右心室顶点(RVA)和RVOT上进行了电生理研究。在180 bpm的快速起搏过程中未观察到IVCA,但在190 bpm的快速起搏过程中观察到了IVCA。然而,即使在没有CS的情况下,由于相对心室不应期,传导速度恢复特性也可能导致这种现象的发展。 CARTO制图系统记录的电压图显示了RVA和RVOT之间的明显低电压区域。因此,我们假设CRT-D感应导线低估了室性快速性心律失常的心率,从而导致其操作失败。适当的干预是通过在RVA中插入额外的传感导线来实现的,迄今为止尚未出现相同的现象。据我们所知,以前没有类似的报告发表过,因此使该案成为极为罕见和有说服力的案子。

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