經電燒治療仍反覆不癒之心室早期收縮的中醫診療病例報告

A Patient with Recurrent Ventricular Premature Contraction after Catheter Ablation :a Traditional Chinese Medicine Case Report

許堯欽(Yao-Chin Hsu) ； 謝元凱(Yuan-Kai Hsieh) ； 許晉嘉(Chin-Chia Hsu)

《北台灣中醫醫學雜誌》 11卷1期 (2019/03) Pp. 39-56

摘要

53歲男性，罹患心律不整多年。因症狀輕微，未規則服藥物控制。三年前胸悶心悸突然加重，嚴重影響生活作息，二十四小時霍特心電圖檢查（以下簡稱Holter EKG）顯示心室早期收縮（Ventricular premature contraction，以下簡稱VPC）佔全部心跳數19.7%。後續接受五次的電燒治療後，VPC數據改善，但臨床症狀卻反而加重，因此來尋求中醫協助。初診時病人臨床症見每日發作胸悶心悸、心跳停拍、心跳減緩，此外還有容易疲倦、焦慮緊張、手足冰冷、呼吸不暢、血壓偏高。上述症狀在工作過勞與緊張時會加劇。中醫辨證為心氣心陽虧虛、伴有陰虛陽亢。治則採補心氣、溫心陽、滋陰潛陽。處方為柴胡桂枝湯合四君子湯加減。後續隨症加溫腎陽的附子、肉桂，再依陰陽互根、陽中求陰的原則，加入養心陰的麥冬、柏子仁、百合與滋腎陰的生地、何首烏。病人服藥後四個月內胸悶心悸時間、強度、頻率均明顯改善，生活品質明顯進步，Holter EKG顯示VPC佔率降為0.7%。我們運用中醫辨證論治順利改善此反覆不癒的心律不整。

關鍵字

心室早期收縮 ； 心律不整 ； 心氣心陽虧虛 ； 陰虛陽亢

並列摘要

A 53-year-old-man suffered from arrhythmia for several years has not taken medicine regularly due to mild symptoms. 3 years ago, the discomfort of chest tightness and palpitation worsened and strikingly affected his daily life. The Holter EKG showed ventricularr premature contraction (VPC), which covered 19.7% of his total heart beats within 1 day. After 5 times of catheter ablation, the ratio of VPC decreased, but his clinical symptoms exaggerated. Thus, he went to the Chinese Medicine Department for help. In his first visit, there were chest tightness, palpitation,occasionally escaped heart beat and bradycardia. Other than these, easily fatigue, anxiety, cold extremity, shortness of breath, and hypertension were noted. Symptoms deteriorated while he was anxious and working. The Traditional Chinese medicine (TCM) pattern differentiation was the dual deficiency of heart qi and heart yang with hyperactivity of yang due to yin deficiency. Our treatment principle was to supply heart qi and heart yang and disperse stagnated liver qi for relieving qi stagnation. Our prescription was Chai Hu Gui Zhi Tang and Si Jun Zi Tang. In the following treatment, we added Fuzi and Rougui to supply kidney yang. Under the principle of seeking yin in yang and interdependence between yin and yang, we added Maidong, Baiziren, and Baihe to nourish heart yin as well as Dihuang and Heshouwu to supply kidney yin. After 4 months of treatment, the duration, extent, and frequency of chest tightness and palpitation improved apparently. His life quality improved vividly and VPC ratio decreased to 0.7%. According to the rule of pattern identification and treatment of TCM, we controlled this recurrent arrhythmia patient successfully.

並列關鍵字

Ventricular Premature Contraction ； Arrhythmia ； Hyperactivity of Yang due to Yin Deficiency

參考文獻

Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm, 15:e190, 2018.

Gupta A, Perera T, Ganesan A, et al. Complications of catheter ablation of atrial fibrillation: a systematic review. Circ Arrhythm Electrophysiol, 6:1082, 2013.

Kay GN, Epstein AE, Dailey SM, Plumb VJ. Role of radiofrequency ablation in the management of supraventricular arrhythmias: experience in 760 consecutive patients. J Cardiovasc Electrophysiol, 4:371, 1993.

Chen SA, Chiang CE, Tai CT, et al. Complications of diagnostic electrophysiologic studies and radiofrequency catheter ablation in patients with tachyarrhythmias: an eight-year survey of 3,966 consecutive procedures in a tertiary referral center. Am J Cardiol, 77:41, 1996.

Scheinman MM, Huang S. The 1998 NASPE prospective catheter ablation registry. Pacing Clin Electrophysiol, 23:1020, 2000.