器質的心疾患に伴う心室頻拍症例の病理学的検討 Electroanatomical Mapping Systemを用い高周波カテーテルアブレーションを施行した3症例
各種器質的心疾患に伴う心室頻拍 (VT) に対しelectroanatomical mapping system (EMS) を用いた高周波カテーテルアブレーション (RFCA) 治療が施行されているが, EMS所見やRFCA後の組織変化に対する病理学的検討はいまだ少ない.EMSを用いVTに対するRFCAを施行した剖検3例 (陳旧性心筋梗塞2例, 拡張相肥大型心筋症1例) を検討した.陳旧性心筋梗塞例はRFCAによるVTの抑制効果が得られたが1例は2年後に再発した.肥大型心筋症例はRFCAによるVT抑制効果は得られなかった.一方でEMSのmapping所見やアブレーション部位は剖検肉眼所見とよ...
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| Published in | 心電図 Vol. 27; no. 2; pp. 167 - 174 |
|---|---|
| Main Authors | , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本不整脈心電学会
25.03.2007
日本心電学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1660 1884-2437 |
| DOI | 10.5105/jse.27.167 |
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| Abstract | 各種器質的心疾患に伴う心室頻拍 (VT) に対しelectroanatomical mapping system (EMS) を用いた高周波カテーテルアブレーション (RFCA) 治療が施行されているが, EMS所見やRFCA後の組織変化に対する病理学的検討はいまだ少ない.EMSを用いVTに対するRFCAを施行した剖検3例 (陳旧性心筋梗塞2例, 拡張相肥大型心筋症1例) を検討した.陳旧性心筋梗塞例はRFCAによるVTの抑制効果が得られたが1例は2年後に再発した.肥大型心筋症例はRFCAによるVT抑制効果は得られなかった.一方でEMSのmapping所見やアブレーション部位は剖検肉眼所見とよく相関した.VTが再発した心筋梗塞例と肥大型心筋症例は病変部の心内膜面が複雑で心筋壁厚が厚く, 特に心筋症例では目標部位のアブレーション効果を十分認めなかった.RFCAの効果には対象となる基礎心疾患が影響し, 心内膜面性状や心室壁厚が関与すると考えられた. |
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| AbstractList | 各種器質的心疾患に伴う心室頻拍 (VT) に対しelectroanatomical mapping system (EMS) を用いた高周波カテーテルアブレーション (RFCA) 治療が施行されているが, EMS所見やRFCA後の組織変化に対する病理学的検討はいまだ少ない.EMSを用いVTに対するRFCAを施行した剖検3例 (陳旧性心筋梗塞2例, 拡張相肥大型心筋症1例) を検討した.陳旧性心筋梗塞例はRFCAによるVTの抑制効果が得られたが1例は2年後に再発した.肥大型心筋症例はRFCAによるVT抑制効果は得られなかった.一方でEMSのmapping所見やアブレーション部位は剖検肉眼所見とよく相関した.VTが再発した心筋梗塞例と肥大型心筋症例は病変部の心内膜面が複雑で心筋壁厚が厚く, 特に心筋症例では目標部位のアブレーション効果を十分認めなかった.RFCAの効果には対象となる基礎心疾患が影響し, 心内膜面性状や心室壁厚が関与すると考えられた. |
| Author | 浅野, 拓 松山, 高明 河村, 光晴 渡辺, 則和 片桐, 敬 酒井, 哲郎 三好, 史人 牧野, 睦月 小林, 洋一 太田, 秀一 井上, 紳 丹野, 郁 |
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| References | 3) Deneke T, Muller KM, Lemke B, Lawo T, Calcum B, Helwing M, Mugge A, Grewe PH: Human histopathology of electroanatomic mapping after cooled-tip radiofrequency ablation to treat ventricular tachycardia in remote myocardial infarction. J Cardiovasc Electrophysiol, 2005; 16: 1246-1251 7) Arenal A, del Castillo S, Gonzalez-Torrecilla E, Atienza F, Ortiz M, Jimenez J, Puchol A, Garcia J, Almendral J Tachycardia-related channel in the scar tissue in patients with sustained monomorphic ventricular tachycardias: influence of the voltage scar definition. Circulation, 2004 ; 110: 2568-2574 8) Fenoglio JJ Jr, Albala A, Silva FG, Friedman PL, Wit AL: Structural basis of ventricular arrhythmias in human myocardial infarction: a hypothesis. Hum Pathol, 1976; 7: 547-563 9) Bolick DR, Hackel DB, Reimer KA, Ideker RE Quantitative analysis of myocardial infarct structure in patients with ventricular tachycardia. Circulation, 1986: 74: 1266-1279 12) Mantica M, Della Bella P, Arena V: Hypertrophic cardiomyopathy with apical aneurysm: a case of catheter and surgical therapy of sustained monomorphic ventricular tachycardia. Heart, 1997; 77: 481-483 5) Soejima K, Stevenson WG, Sapp JL, Selwyn AP, Couper G, Epstein LM: Endocardial and epicardial radiofrequency ablation of ventricular tachycardia associated with dilated cardiomyopathy: the importance of low-voltage scars. J Am Coil Cardiol, 2004; 43 : 1834-1842 1) Marchlinski FE, Callans DJ, Gottlieb CD, Zado E Linear ablation lesions for control of unmappable ventricular tachycardia in patients with ischemic and nonischemic cardiomyopathy. Circulation, 2000; 101: 1288-1296 11) Falicov RE, Resnekov L, Bharati S, Lev M: Mid-ventricular obstruction: a variant of obstructive cardiomyopathy. Am J Cardiol, 1976; 37: 432-437 2) Kautzner J, Cihak R, Peichl P, Vancura V, Bytesnik J: Catheter ablation of ventricular tachycardia following myocardial infarction using three-dimensional electroanatomical mapping. Pacing Clin Electrophysiol, 2003; 26: 342-347 6) Stevenson WG, Khan H, Sager P, Saxon LA, Middlekauff HR, Natterson PD, Wiener I: Identification of reentry circuit sites during catheter mapping and radiofrequency ablation of ventricular tachycardia late after myocardial infarction. Circulation, 1993; 88: 1647-1670 4) Verma A, Marrouche NF, Schweikert RA, Saliba W, Wazni O, Cummings J, Abdul-karim A, Bhargava M, Burkhardt JD, Kilicaslan F, Martin DO, Natale A: Relationship between successful ablation sites and the scar border zone defined by substrate mapping for ventricular tachycardia post-myocardial infarction. J Cardiovasc Electrophysiol, 2005 ; 16: 465-471 10) Yutani C, Imakita M, Ishibashi-Veda H, Isobe F, Ohe T: Histopathological analysis of surgically resected myocardium in patients with sustained ventricular tachycardia. Acta Pathol Jpn, 1988; 38: 605-613 |
| References_xml | – reference: 12) Mantica M, Della Bella P, Arena V: Hypertrophic cardiomyopathy with apical aneurysm: a case of catheter and surgical therapy of sustained monomorphic ventricular tachycardia. Heart, 1997; 77: 481-483 – reference: 6) Stevenson WG, Khan H, Sager P, Saxon LA, Middlekauff HR, Natterson PD, Wiener I: Identification of reentry circuit sites during catheter mapping and radiofrequency ablation of ventricular tachycardia late after myocardial infarction. Circulation, 1993; 88: 1647-1670 – reference: 1) Marchlinski FE, Callans DJ, Gottlieb CD, Zado E Linear ablation lesions for control of unmappable ventricular tachycardia in patients with ischemic and nonischemic cardiomyopathy. Circulation, 2000; 101: 1288-1296 – reference: 10) Yutani C, Imakita M, Ishibashi-Veda H, Isobe F, Ohe T: Histopathological analysis of surgically resected myocardium in patients with sustained ventricular tachycardia. Acta Pathol Jpn, 1988; 38: 605-613 – reference: 11) Falicov RE, Resnekov L, Bharati S, Lev M: Mid-ventricular obstruction: a variant of obstructive cardiomyopathy. Am J Cardiol, 1976; 37: 432-437 – reference: 3) Deneke T, Muller KM, Lemke B, Lawo T, Calcum B, Helwing M, Mugge A, Grewe PH: Human histopathology of electroanatomic mapping after cooled-tip radiofrequency ablation to treat ventricular tachycardia in remote myocardial infarction. J Cardiovasc Electrophysiol, 2005; 16: 1246-1251 – reference: 7) Arenal A, del Castillo S, Gonzalez-Torrecilla E, Atienza F, Ortiz M, Jimenez J, Puchol A, Garcia J, Almendral J Tachycardia-related channel in the scar tissue in patients with sustained monomorphic ventricular tachycardias: influence of the voltage scar definition. Circulation, 2004 ; 110: 2568-2574 – reference: 8) Fenoglio JJ Jr, Albala A, Silva FG, Friedman PL, Wit AL: Structural basis of ventricular arrhythmias in human myocardial infarction: a hypothesis. Hum Pathol, 1976; 7: 547-563 – reference: 2) Kautzner J, Cihak R, Peichl P, Vancura V, Bytesnik J: Catheter ablation of ventricular tachycardia following myocardial infarction using three-dimensional electroanatomical mapping. Pacing Clin Electrophysiol, 2003; 26: 342-347 – reference: 4) Verma A, Marrouche NF, Schweikert RA, Saliba W, Wazni O, Cummings J, Abdul-karim A, Bhargava M, Burkhardt JD, Kilicaslan F, Martin DO, Natale A: Relationship between successful ablation sites and the scar border zone defined by substrate mapping for ventricular tachycardia post-myocardial infarction. J Cardiovasc Electrophysiol, 2005 ; 16: 465-471 – reference: 5) Soejima K, Stevenson WG, Sapp JL, Selwyn AP, Couper G, Epstein LM: Endocardial and epicardial radiofrequency ablation of ventricular tachycardia associated with dilated cardiomyopathy: the importance of low-voltage scars. J Am Coil Cardiol, 2004; 43 : 1834-1842 – reference: 9) Bolick DR, Hackel DB, Reimer KA, Ideker RE Quantitative analysis of myocardial infarct structure in patients with ventricular tachycardia. Circulation, 1986: 74: 1266-1279 |
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| Snippet | 各種器質的心疾患に伴う心室頻拍 (VT) に対しelectroanatomical mapping system (EMS) を用いた高周波カテーテルアブレーション (RFCA) 治療が施行されているが, EMS所... 各種器質的心疾患に伴う心室頻拍(VT)に対しelectroanatomical mapping system(EMS)を用いた高周波カテーテルアブレーション(RFCA)治療が施行されているが, EMS所見やRFCA... |
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| SubjectTerms | カテーテルアブレーション 心室頻拍 肥大型心筋症 陳旧性心筋梗塞 |
| Subtitle | Electroanatomical Mapping Systemを用い高周波カテーテルアブレーションを施行した3症例 |
| Title | 器質的心疾患に伴う心室頻拍症例の病理学的検討 |
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