First episode of ventricular fibrillation in an 84-year-old man with long-QT type 2 syndrome: A case report
First episode of ventricular fibrillation in an 84-year-old man with long-QT type 2 syndrome: A case report
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一名 84 岁 2 型长 QT 综合征男性首次室颤发作：病例报告
DOI：
10.1016/j.jccase.2020.07.012
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发表时间：
2020
影响因子：
--
通讯作者：
Matoba Satoaki
中科院分区：
文献类型：
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作者：
Miki Tomonori;Senoo Keitaro;Okura Takashi;Shiraishi Hirokazu;Shirayama Takeshi;Aiba Takeshi;Matoba Satoaki
先天性长QT综合征（LQTS）与室性心律失常和年轻人心源性猝死的风险增加有关。然而，这是极其罕见的老年人经历心室颤动（VF）由于先天性LQTS作为第一次发作。我们描述的情况下，84岁的男子谁经历晕厥后小便。他有高血压和哮喘病史，但没有晕厥病史。2017年心电图结果显示QT延长（校正后QT = 505 ms）。未使用可导致QT延长的药物。入院时血液检查未见电解质异常，超声心动图未见异常。第二次意识丧失发生在住院期间，心电图显示连续的点扭转，由慢性心律失常引起的短-长-短（SLS）序列的R-on-T引起。冠状动脉造影未检测到心肌缺血，植入了植入式心律转复除颤器进行二级预防。基因检测显示kcnh2基因突变，提示LQTS 2型。综上所述，我们报告了一例罕见的QT间期延长伴SLS序列的病例，这是由于病态窦性综合征引发的VF作为老年LQTS 2型患者的首次发作。学习目标：医生应意识到QT间期延长是老年患者晕厥的原因之一，应注意QT间期的持续时间。此外，老年起病QT间期延长的患者可能具有先天性长QT综合征（LQTS）相关的遗传背景；因此，如果怀疑老年患者有LQTS，我们应该毫不犹豫地进行基因检测
Congenital long QT syndrome (LQTS) is associated with ventricular arrhythmia and an increased risk of sudden cardiac death in young people. However, it is extremely rare for an elderly man to experience ventricular fibrillation (VF) due to congenital LQTS as a first episode. We describe the case of an 84-year-old man who experienced syncope after urination. He had a medical history of hypertension and asthma, but no history of syncope. Electrocardiographic findings in 2017 showed QT prolongation (corrected QT = 505 ms). No medication that could induce QT prolongation was administered. Blood test results on admission showed no electrolyte abnormalities, and there were no abnormal findings on echocardiography. The second episode of loss of consciousness occurred during hospitalization, and electrocardiography revealed incessant torsade de pointes, caused by R-on-T with short-long-short (SLS) sequences due to bradyarrhythmia. Coronary angiography did not detect myocardial ischemia, and an implantable cardioverter-defibrillator was implanted for secondary prevention. Genetic testing revealed a mutation of theKCNH2gene, indicating LQTS type 2. In summary, we report a rare case of prolonged QT interval with SLS sequences due to sick sinus syndrome triggering VF as the first attack in an elderly patient with LQTS type 2.<Learning objective:Physicians should be aware of the prolongation of QT as a cause of syncope in elderly patients and should pay attention to QT duration. Furthermore, patients with elderly-onset QT prolongation may have a genetic background associated with congenital long QT syndrome (LQTS); therefore, we should not hesitate to perform genetic testing in cases where LQTS is suspected in elderly patients.>