植入式心臟去顫器反覆放電之年輕擴張型心肌症

Dilated Cardiomyopathy with Recurrent Implantable Cardioverter-Defibrillator Shocks

本文報告一位32歲女性，診斷為擴張型心肌症，病因推測與潛在家族遺傳因素及2022年接種AZ疫苗後心肌炎相關。病人2023年發生院外心臟停止，隨後植入一顆植入式心臟去顫器（implantable cardioverter defibrillator，ICD）作為次級預防。本次因24小時內2次ICD電擊而入院，顯示為頑固型心室頻脈（ventricular tachycardia，VT）反覆發作。雖入院時生命徵象相對穩定，經藥物治療與ICD參數調整後仍無法有效控制致死性心律不整。經多專科團隊評估後安排導管消融術，術後病況穩定，返家接受規則門診追蹤。本案例突顯，面臨頑固型VT導致ICD頻繁放電時，臨床處置不應僅侷限於裝置設定與藥物調整，而應進一步評估導致心律不整因素是否獲得有效處理。及早採取導管消融術，有助降低致死性心律不整再發率、減少頻繁放電對心肌的再傷害，進而改善病人生活品質與整體預後。

We report a 32-year-old woman diagnosed with dilated cardiomyopathy (DCM), with an etiology attributed to underlying familial genetic predisposition and suspected myocarditis following AstraZeneca (AZ) COVID-19 vaccination in 2022. The patient experienced an out-of-hospital cardiac arrest (OHCA) in 2023 and subsequently underwent implantation of an implantable cardioverter-defibrillator (ICD) for secondary prevention. She was admitted following two ICD shocks within 24 hours, indicative of recurrent refractory ventricular tachycardia (VT). Despite hemodynamically stable presentation at admission, pharmacological therapy and ICD parameter optimization failed to adequately suppress the life-threatening arrhythmia. Following multidisciplinary team evaluation, catheter ablation was performed, with favorable postoperative outcomes and stable follow-up on an outpatient basis. This case highlights that in the setting of refractory VT with recurrent ICD shocks, clinical management should not be restricted to device reprogramming and pharmacological adjustment alone. Systematic evaluation of the underlying arrhythmia substrate is warranted. Early adoption of catheter ablation may reduce arrhythmia recurrence, mitigate ongoing myocardial injury attributable to repeated shock delivery, and ultimately improve patient quality of life and overall prognosis.