The case of epicardial ventricular tachycardia with ICD storm recoeded far field potential of mid diastolic potential from endocardium
症例は71歳, 男性, 陳旧性心筋梗塞に伴う心室頻拍(VT)の診断で植込み型除細動器(ICD)を留置され, 外来フォローされていた. 入院当日, 朝方より頻回のICD作動があり, 入院の上, 抗不整脈薬を投与したが, VTの抑制が困難で準緊急的にカテーテルアブレーション(CA)を施行した. 心内膜側には, 心尖部を中心に広範な低電位領域(LVA)を認めるも再現性のあるdelayed potentialは認めなかった. Clinical VT(RBBB, CL 446msec)中にも拡張期にはvoltageの低いdullな電位が認められるのみで, 局所電位を示すようなmid diastolic...
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| Published in | Shinzo Vol. 43; no. SUPPL.3; pp. S3_117 - S3_124 |
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| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japan Heart Foundation
2011
公益財団法人 日本心臓財団 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0586-4488 2186-3016 |
| DOI | 10.11281/shinzo.43.S3_117 |
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| Abstract | 症例は71歳, 男性, 陳旧性心筋梗塞に伴う心室頻拍(VT)の診断で植込み型除細動器(ICD)を留置され, 外来フォローされていた. 入院当日, 朝方より頻回のICD作動があり, 入院の上, 抗不整脈薬を投与したが, VTの抑制が困難で準緊急的にカテーテルアブレーション(CA)を施行した. 心内膜側には, 心尖部を中心に広範な低電位領域(LVA)を認めるも再現性のあるdelayed potentialは認めなかった. Clinical VT(RBBB, CL 446msec)中にも拡張期にはvoltageの低いdullな電位が認められるのみで, 局所電位を示すようなmid diastolic potentialは認めず, pace mappingが一致する部位, VTの最早期での通電は無効であった. 続いて心外膜側にアプローチし, 心尖部を中心とするLVA内にdelayed potentialが確認され, 同部位でのペーシングにてclinical VTと一致した波形が認められ, そのままclinical VTが誘発された. 同部位ではmid diastolic potentialが記録され, 通電により4.6秒でVTは停止, 周辺部位に通電を追加しセッションを終了した. VTが停止した通電部位が心内膜側でvoltageの低いdullな拡張期電位が認められた部位と解剖学的に近接していた. その後は, 抗不整脈薬を投与せず経過観察し, ICD作動を認めていない. 心外膜側でconcealed entrainmentが確認され, 心外膜アプローチによるCAにより救命しえた貴重な1例と考えられ, また, 心外膜側のmid diastolic potentialのfar field potentialが心内膜側から観察された稀な1例と考えられ, 報告する. |
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| AbstractList | 症例は71歳, 男性, 陳旧性心筋梗塞に伴う心室頻拍(VT)の診断で植込み型除細動器(ICD)を留置され, 外来フォローされていた. 入院当日, 朝方より頻回のICD作動があり, 入院の上, 抗不整脈薬を投与したが, VTの抑制が困難で準緊急的にカテーテルアブレーション(CA)を施行した. 心内膜側には, 心尖部を中心に広範な低電位領域(LVA)を認めるも再現性のあるdelayed potentialは認めなかった. Clinical VT(RBBB, CL 446msec)中にも拡張期にはvoltageの低いdullな電位が認められるのみで, 局所電位を示すようなmid diastolic potentialは認めず, pace mappingが一致する部位, VTの最早期での通電は無効であった. 続いて心外膜側にアプローチし, 心尖部を中心とするLVA内にdelayed potentialが確認され, 同部位でのペーシングにてclinical VTと一致した波形が認められ, そのままclinical VTが誘発された. 同部位ではmid diastolic potentialが記録され, 通電により4.6秒でVTは停止, 周辺部位に通電を追加しセッションを終了した. VTが停止した通電部位が心内膜側でvoltageの低いdullな拡張期電位が認められた部位と解剖学的に近接していた. その後は, 抗不整脈薬を投与せず経過観察し, ICD作動を認めていない. 心外膜側でconcealed entrainmentが確認され, 心外膜アプローチによるCAにより救命しえた貴重な1例と考えられ, また, 心外膜側のmid diastolic potentialのfar field potentialが心内膜側から観察された稀な1例と考えられ, 報告する. |
| Author | Goya, Masahiko Niu, Harushi Ohe, Masatsugu Nagashima, Michio Fukunaga, Masato Hayashi, Kentaro An, Yoshimori Iwabuchi, Masashi Hiroshima, Kenichi Makihara, Yu Nobuyoshi, Masakiyo |
| Author_FL | 合屋 雅彦 延吉 正清 岩淵 成志 廣島 謙一 永島 道雄 安 珍守 牧原 優 福永 真人 大江 征嗣 林 健太郎 丹生 治司 |
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| References | 6) Robert H, et al: Termination of ventricular tachycardia with epicardial laser photocoagulation: A clinical comparison with patients undergoing successful endocardial photocoagulation alone. J Am Coll Cardiol 1990; 15: 163-170 5) Delacretaz E, et al: Mapping and radiofrequency catheter ablation of the three types of sustained monomorphic ventricular tachycardia in nonischemic heart disease. J Cardiovasc Electrophysiol 2000; 11: 11-17 7) Soejima K, et al: Endocardial and epicardial radiofrequency ablation of ventricular tachycardia associated with of dilated cardiomyopathy: the importance of low-voltage scars. J Am Coll Cardiol 2004; 43: 1834-1842 2) Carbucicchio C, et al: Catheter ablation for the treatment of electrical storm in patients with implantable cardioverter-defibrillators: short and long term outcomes in a prospective single center study 2008; 117: 462-469 1) Jeanne E, Poole, et al: Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med 2008; 359: 1009-1017 3) Sosa E, et al: Nonsurgical transthoracic epicardial catheter ablation to treat recurrent ventricular tachycardia occurring late after myocardial infarction. J Am Coll Cardiol 2000; 35: 1442-1449 4) Hsia HH, et al: Characterization of endocardial electrophysiological substrate in patients with nonischemic cardiomyopathy and monomorphic ventricular tachycardia. Circulation 2003; 108: 704-710 |
| References_xml | – reference: 6) Robert H, et al: Termination of ventricular tachycardia with epicardial laser photocoagulation: A clinical comparison with patients undergoing successful endocardial photocoagulation alone. J Am Coll Cardiol 1990; 15: 163-170 – reference: 3) Sosa E, et al: Nonsurgical transthoracic epicardial catheter ablation to treat recurrent ventricular tachycardia occurring late after myocardial infarction. J Am Coll Cardiol 2000; 35: 1442-1449 – reference: 2) Carbucicchio C, et al: Catheter ablation for the treatment of electrical storm in patients with implantable cardioverter-defibrillators: short and long term outcomes in a prospective single center study 2008; 117: 462-469 – reference: 1) Jeanne E, Poole, et al: Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med 2008; 359: 1009-1017 – reference: 4) Hsia HH, et al: Characterization of endocardial electrophysiological substrate in patients with nonischemic cardiomyopathy and monomorphic ventricular tachycardia. Circulation 2003; 108: 704-710 – reference: 7) Soejima K, et al: Endocardial and epicardial radiofrequency ablation of ventricular tachycardia associated with of dilated cardiomyopathy: the importance of low-voltage scars. J Am Coll Cardiol 2004; 43: 1834-1842 – reference: 5) Delacretaz E, et al: Mapping and radiofrequency catheter ablation of the three types of sustained monomorphic ventricular tachycardia in nonischemic heart disease. J Cardiovasc Electrophysiol 2000; 11: 11-17 |
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| Snippet | 症例は71歳, 男性, 陳旧性心筋梗塞に伴う心室頻拍(VT)の診断で植込み型除細動器(ICD)を留置され, 外来フォローされていた. 入院当日, 朝方より頻回のICD作動があり, 入... |
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| SubjectTerms | catheter ablation concealed entrainment epicardial approach mid diastolic potential ventricular tachycardia |
| Title | The case of epicardial ventricular tachycardia with ICD storm recoeded far field potential of mid diastolic potential from endocardium |
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