Back somersault-induced atrioventricular nodal reentrant tachycardia ? A case of a 15-year-old promising gymnast
Back somersault-induced atrioventricular nodal reentrant tachycardia ? A case of a 15-year-old promising gymnast
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后空翻诱发房室结折返性心动过速？
DOI：
10.1016/j.jccase.2020.12.004
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发表时间：
2021
影响因子：
--
通讯作者：
Hasebe Naoyuki
中科院分区：
文献类型：
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作者：
Hayasaka Taiki;Kawamura Yuichiro;Kobayashi Yuya;Kitani Yuya;Hontani Misako;Sugiyama Eitaro;Sumitomo Kazuhiro;Tanabe Yasuko;Akasaka Kazumi;Takeuchi Toshiharu;Sato Nobuyuki;Hirasawa Kunihiko;Hasebe Naoyuki
一位15岁的有前途的体操运动员患有心悸，只有在落地后翻一个圆后才出现。该性能诱导了规则窄QRS波群心动过速的发作，具有高度可重复性。不是表演的一个元素，而是一个完整的后空翻序列需要诱导攻击。电生理研究显示结内双径路引起房室结折返性心动过速（AVNRT）。偶然发现了一个微小的房间隔缺损（ASD）的并发症，因此我们最初怀疑ASD的因果关系是扁平呼吸-直立性缺氧综合征。然而，它被否认是主要的攻击机制，因为在一圈后空翻过程中存在非常微弱的分流，并且没有诱发低氧血症。一个完整的后空翻序列的主要触发机制被推测为与短暂的心房过载和自主神经失衡引起的一个快速的姿势轴的变化，以及强烈的Valsalva动作与最大水平的屏气。AVNRT发作通过射频导管消融术成功治疗，即使是一系列的旋转后空翻也从未复发。目前他是一名健康活跃的体操运动员，没有任何症状。<学习目标：房室结折返性心动过速（AVNRT）发作的个体触发因素各不相同。在目前的体操运动员案例中，独特的和唯一的攻击触发器是一个完整的后空翻序列。快速的体位轴向改变和剧烈的Valsalva动作，最大程度的屏气，增加了心房负荷，牵拉了心房壁，这可能诱发了房性期前收缩，并在AVNRT发作中起了触发作用。
A male 15-year-old promising gymnast suffered palpitations, which emerged only after landing a round-off back somersault. The performance induced an attack of regular narrow QRS complex tachycardia that was highly reproducible. Not a single element of the performance, but a whole sequence of round-off back somersault was required to induce the attack. An electrophysiologic study revealed an intra-nodal dual pathway causing atrioventricular nodal reentrant tachycardia (AVNRT). A complication of a tiny atrial septal defect (ASD) was incidentally detected, thus we initially suspected a causal relation of ASD as the platypnea-orthodeoxia syndrome. However, it was denied as the major mechanism of attack because of a very faint shunt flow and no-induction of hypoxemia during a round-off back somersault. The major triggering mechanisms of a whole sequence of round-off back somersaults were speculated to be related to transient atrial overload and autonomic imbalance induced by a swift postural-axial change together with an intense Valsalva maneuver with the maximal level of breath holding. The AVNRT attack was successfully treated by radiofrequency catheter ablation and has never recurred even by a whole sequence of round-off back somersaults. Currently he is a healthy and active gymnast with no symptoms.<Learning objective:The individual trigger of an atrioventricular nodal reentrant tachycardia (AVNRT) attack varies. The unique and sole trigger of the attack in the present gymnast case was a whole sequence of round-off back somersaults. A swift postural-axial change together with an intense Valsalva maneuver with the maximal level of breath holding increased the atrial overload with stretching the atrial wall, which might have induced atrial extrasystole and played a trigger role initiating the AVNRT attack.>