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目的 探讨奥密克戎感染相关难治性心律失常的种类,临床特点,潜在机制,处理及转归。方法 回顾分析2022年12月至2023年1月奥密克戎感染爆发期间,14例难治性心律失常患者,其中男性7例,女性7例,年龄15~92(70.1±19.8)岁。既往有致心律失常性右室发育不良及扩张型心肌病植入ICD患者各1例,肥厚型心肌病1例,分析心律失常出现时间,以及与血氧饱和度、炎症指标、心肌标志物、D-二聚体相关性,治疗方法及临床转归。结果 心律失常出现于奥密克戎感染后1~7天,包括左后分支型室速2例;阵发性房颤8例,其中合并尖端扭转型室速2例;右室心尖起源室速电风暴1例;房室阻滞3例,其中完全性房室阻滞2例,一度房室阻滞1例。白介素-6、肌钙蛋白I、D-二聚体升高,低氧血症与房颤,尖端扭转型室速及完全性房室阻滞密切相关。死亡5例,均为高龄房颤患者;2例ICD植入后疑似电风暴经远程随访指导治疗后稳定,1例完全性房室阻滞恢复正常房室传导。两例尖端扭转型室速停用胺碘酮及左氧氟沙星后消失,2例左后分支型室速经口服维拉帕米后得到控制。结论 奥密克戎感染急性期易出现顽固性心律失常,低氧、炎症风暴、心肌损伤是心律失常的可能原因,某些抗生素及抗心律失常药联合治疗可延长QTc间期,房颤在感染急性期建议控制心室率为主,ICD植入患者易发生电风暴,远程随访技术可及时指导治疗。
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