STRAŽNJA IDIOPATSKA FASCIKULARNA LJEVOVENTRIKULARNA TAHIKARDIJA OSJETLJIVA NA VERAPAMIL – BELHASSENOVA TAHIKARDIJA – PRIKAZ BOLESNIKA

Lidija Srkoč Majčica, Ivan Malčić

Uvod: Prikazujemo rijetku ventrikularnu tahikardiju nepoznata uzroka (idiopatsku) s ishodištem u blizini stražnjeg snopića (fascikula) lijeve grane Hisova snopa, koja se očituje četirima osnovnim obilježjima: široki QRS-kompleksi, blok desne grane, lijeva (superiorna) električna os i osjetljivost na verapamil. Od 1981. godine, kada je Belhassen sa suradnicima otkrio osjetljivost na verapamil, često se naziva Belhassenova tahikardija. Cilj: Osnovna svrha ovog prikaza jest podsjetiti da se već ispravnom interpretacijom EKG-a može postaviti točna dijagnoza ove potencijalno opasne aritmije. Prikaz bolesnika: Do sada zdrava djevojčica adolescentne dobi došla je u hitnu službu zbog palpitacija, dispneje i presinkopalne krize. Na 12-kanalnom EKG zapisu našli smo čak tri od četiri obilježja stražnje idiopatske fascikularne ljevoventrikularne tahikardije, a konverzijom u sinusni ritam nakon intravenske primjene verapamila zadovoljeno je četvrto obilježje i time je potvrđena elektrokardiografska sumnja. Zbog učestalih recidiva ventrikularne tahikardije uza sve češće subjektivne tegobe srčane naravi (palpitacije, prekordijalne opresije, vrtoglavice, presinkopalne krize), a usprkos sve višoj peroralnoj dozi verapamila te uzevši u obzir pozitivnu obiteljsku anamnezu na iznenadnu smrt, upućena je na elektrofiziološko ispitivanje i liječenje radiofrekventnom ablacijom. Zaključak: Temeljitom i dobrom analizom 12-kanalnog EKG-a može se postaviti točna dijagnoza vrste tahikardije, što je uvjet daljnjeg ispravnog postupanja i liječenja.

Introduction: We present a rare ventricular tachycardia of unknown origin (idiopathic) which originates near the posterior fascicle of the left bundle branch of His. The tachycardia has four basic features: wide QRS complex, RBBB morphology, left (superior) axis deviation and sensitivity to verapamil. Since 1981 (when sensitivity to verapamil was discovered by Belhassen et al.) it has frequently been called Belhassen’s tachycardia. Aim: The purpose of this case report was to remind that correct diagnosis of this potentially dangerous arrhythmia can be made with detailed and correct interpretation of 12-lead ECG. Case report: Until now healthy adolescent girl came to the ER because of palpitations, dyspnoea and presyncopal attack. The 12-lead ECG was done. It showed three of four basic features of posterior idiopathic fascicular left ventricular tachycardia. After the conversion of tachycardia to sinus rhythm by intravenous application of verapamil, the fourth feature was also shown and by that the diagnosis was confirmed. Because of the frequent recurrence of ventricular tachycardia with clinical symptoms associated with cardiovascular system (palpitations, precordial oppressions, dizziness, presyncopal crisis) despite ever increasing dosage of oral verapamil and with taking into consideration a positive family history of sudden death syndrome, the adolescent girl was referred to the electrophysiology study and treatment with radiofrequency ablation. Conclusion: Detailed and correct interpretation of 12-lead ECG can correctly diagnose the type of tachycardia, which is fundamental for efficient managing and treatment.