Ölümcül İkili: Couplet Ventriküler Erken Vurunun İndüklediği Dilate Kardiyomiyopatiye Yaklaşım
Özet
Ventriküler erken vurular (VEV), klinikte sık karşılaşılan ve genellikle iyi seyirli kabul edilen aritmilerdir; ancak dilate kardiyomiyopati, kalp yetersizliği ve ani kardiyak ölüme yol açabilen malign bir klinik seyir de gösterebilirler. Bu çalışmada, çarpıntı, baş dönmesi, presenkop ve kalp yetmezliği semptomlarıyla başvuran 43 yaşında yüksek riskli bir erkek hasta sunulmuştur. Hastanın elektrokardiyografisinde, T dalgasının inen kısmı üzerine gelen ikili (couplet) VEV'ler izlenmiş ve ekokardiyografisinde sol ventrikül çaplarının dilate olduğu ile ejeksiyon fraksiyonunun %35'e düştüğü tespit edilmiştir. Koroner arterleri normal saptanan hastaya, üç boyutlu (3D) haritalama (CARTO) yöntemi kullanılarak sağ ventrikül çıkış yolundan (RVOT) posteroseptal bölgeye irrigasyonlu kateter ile radyofrekans ablasyon tedavisi başarıyla uygulanmıştır. İşlem sonrasındaki takiplerde VEV izlenmemiş ve hasta taburcu edilmiştir. Son zamanlarda 3D haritalama ve kateter ablasyon yöntemlerindeki teknolojik gelişmeler, yüksek tedavi başarısı ve düşük işlem riskleri sunarak sık VEV'lerin indüklediği sol ventrikül disfonksiyonunun ve kardiyomiyopatilerin geri döndürülmesinde ilk seçenek tedavi haline gelmiştir.
Premature ventricular complexes (PVCs) are common arrhythmias in clinical practice that are generally considered benign; however, they can exhibit a malignant clinical course leading to dilated cardiomyopathy, heart failure, and sudden cardiac death. This study presents a high-risk 43-year-old male patient who presented with symptoms of palpitations, dizziness, presyncope, and heart failure. The patient's electrocardiography revealed couplet PVCs falling on the descending limb of the T wave, and echocardiography demonstrated dilated left ventricular diameters with an ejection fraction reduced to 35%. The patient, whose coronary arteries were found to be normal, successfully underwent radiofrequency catheter ablation targeting the posteroseptal region of the right ventricular outflow tract (RVOT) using a three-dimensional (3D) mapping system (CARTO). No recurrence of PVCs was observed during the post-procedural follow-up, and the patient was discharged safely. Recent technological advancements in 3D mapping and catheter ablation techniques provide high treatment success and low procedural risks, making them the primary treatment options for reversing left ventricular dysfunction and cardiomyopathies induced by frequent PVCs.
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