心肺停止から蘇生したIto-mediated J wave syndromeの1例
症例は40歳, 男性. 生来健康で健康診断は受けていなかった. 安静時に失神・痙攣しているところを家人が発見した. 救急隊現着時は心肺停止状態で, 心肺蘇生を行ったところ, 心室細動が出現し, 除細動施行したが再度心肺停止状態となった. 4分後に自己心拍が再開し当院に搬送された. 入院時心電図でII, III, aVF, V4～6でJ波を認めた. 心エコーや冠動脈造影などで器質的異常は認めなかった. ホルター心電図では徐脈時にJ波が出現し, 頻脈時にはJ波が消失した. 電気生理学的検査では右室心尖部からのプログラム刺激でJ波の上昇が明瞭になり, イソプロテレノール負荷でJ波は消失した. ピルジ...
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| Published in | Shinzo Vol. 41; no. SUPPL.3; pp. S3_47 - S3_53 |
|---|---|
| Main Authors | , , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
公益財団法人 日本心臓財団
2009
Japan Heart Foundation |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0586-4488 2186-3016 |
| DOI | 10.11281/shinzo.41.S3_47 |
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| Abstract | 症例は40歳, 男性. 生来健康で健康診断は受けていなかった. 安静時に失神・痙攣しているところを家人が発見した. 救急隊現着時は心肺停止状態で, 心肺蘇生を行ったところ, 心室細動が出現し, 除細動施行したが再度心肺停止状態となった. 4分後に自己心拍が再開し当院に搬送された. 入院時心電図でII, III, aVF, V4～6でJ波を認めた. 心エコーや冠動脈造影などで器質的異常は認めなかった. ホルター心電図では徐脈時にJ波が出現し, 頻脈時にはJ波が消失した. 電気生理学的検査では右室心尖部からのプログラム刺激でJ波の上昇が明瞭になり, イソプロテレノール負荷でJ波は消失した. ピルジカイニド負荷では心電図上V1, 2の第2肋間上で有意なcoved型ST上昇を認めた. J波の変動は自律神経に影響されItoの関連が示唆された. Ito-mediated J wave syndromeによると考えられる心肺停止から蘇生した1例を経験した. |
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| AbstractList | 症例は40歳, 男性. 生来健康で健康診断は受けていなかった. 安静時に失神・痙攣しているところを家人が発見した. 救急隊現着時は心肺停止状態で, 心肺蘇生を行ったところ, 心室細動が出現し, 除細動施行したが再度心肺停止状態となった. 4分後に自己心拍が再開し当院に搬送された. 入院時心電図でII, III, aVF, V4～6でJ波を認めた. 心エコーや冠動脈造影などで器質的異常は認めなかった. ホルター心電図では徐脈時にJ波が出現し, 頻脈時にはJ波が消失した. 電気生理学的検査では右室心尖部からのプログラム刺激でJ波の上昇が明瞭になり, イソプロテレノール負荷でJ波は消失した. ピルジカイニド負荷では心電図上V1, 2の第2肋間上で有意なcoved型ST上昇を認めた. J波の変動は自律神経に影響されItoの関連が示唆された. Ito-mediated J wave syndromeによると考えられる心肺停止から蘇生した1例を経験した. |
| Author | 若林, 公平 佐藤, 督忠 鈴木, 洋 清水, 信行 嶽山, 陽一 本田, 雄気 若月, 大輔 東, 祐圭 前澤, 秀之 浅野, 冬樹 下島, 桐 山谷, 清香 江波戸, 美緒 |
| Author_FL | Higashi Yukei Asano Fuyuki Honda Yuki Sato Tokutada Wakabayashi Kohei Ebato Mio Takeyama Youichi Shimizu Nobuyuki Wakatsuki Daisuke Suzuki Hiroshi Yamaya Sayaka Shimojima Hisa Maezawa Hideyuki |
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| References | 11) Brugada P, Brugada J: Right bundle branch block, persistent ST segment elevation and sudden cardiac death: A distinct clinical and electrocardiographic syndrome. J Am Coll Cardiol 1992; 20: 1391-1396 13) Antzelevitch C: The Brugada syndrome: ionic basis and arrhythmia mechanisms. J Cardiovasc Electrophysiol 2001; 12: 268-272 6) Sahara M, Sagara K, Yamashita T, et al: J Wave and ST Segment Elevation in the Inferior Leads. Jpn Heart J 2002; 43: 55-60 18) Ikeda T, Sakurada H, Sakabe K, et al: Assessment of noninvasive markers in identifying patients at risk in the Brugada syndrome: Insight into risk stratification. J Am Coll Cardiol 2000; 37: 1628-1634 20) Ohkubo K, Watanabe I, Takagi Y, et al: Endocardial Electrograms From the Right Ventricular Outflow Tract After Induced Ventricular Fibrillation in Patients With Brugada Syndrome. Circ J 2007; 71: 1258-1262 14) Gussak I, Antzelevitch C: Early Repolarization Syndrome: Clinical Characteristics and Possible Cellular and Ionic Mechanisms. Journal of Electrocardiology 2000; 33; 299-309 1) Gussak I, Antzelevitch C: Early repolarization syndrome: clinical characteristics and possible cellular and ionic mechanisms. J Electrocardiol 2000; 33: 299-309 5) Letsas KP, Efremidis M, Pappas LK, et al: Early repolarization syndrome: Is it always benign? International Journal of Cardiology 2007; 114: 390-392 4) Kalla H, Yan GX, Marinchak R: Ventricular fibrillation in a patient with prominent J (Osborn) waves and ST segment elevation in the inferior electrocardiographic leads: A Brugada syndrome variant? J Cardiovasc Electrophysiol 2000; 11: 95-98 21) Nagase S, Kusano KF, Morita H, et al: Epicardial electrogram of the right ventricular outflow tract in patients with Brugada syndrome: using the epicardial lead. JACC 2002; 39: 1992-1995 15) Yan G-X, Lankipalli RS, Burke JF, et al: Ventricular Repolarization Components on the Electrocardiogram Cellular Basis and Clinical Significance. J Am Coll Cardiol 2003; 42: 401-409 17) Junttila MJ, Brugada P, Hong K, et al: Differences in 12-Lead Electrocardiogram Between Symptomatic and Asymptomatic Brugada Syndrome Patients. J Cardiovasc Electrophysiol 2008; 19: 380-383 23) Benito B, Brugada R, Brugada J Brugada P: Brugada syndrome. Progress in Cardiovascular Diseases 2008; 51: 1-22 3) Takagi M, Aihara N, Takaki H, et al: Clinical characteristics of patients with spontaneous or inducible ventricular fibrillation without apparent heart disease presenting with J wave and ST segment elevation in inferior leads. J Cardiovasc Electrophysiol 2000; 11: 844-846 8) Ozeke O, Aras D, Celenk MK, et al: Exerciseinduced ventricular tachycardia associated with J point ST-segment elevation in inferior leads in a patient without apparent heart disease: a variant form of Brugada syndrome? Journal of Electrocardiology 2006; 39: 409-412 10) Shu J, Zhu T, Yang L, et al: ST-segment elevation in the early repolarization syndrome, idiopathic ventricular fibrillation, and the Brugada syndrome: cellular and clinical linkage. J Electrocardiol 2005; 38: 26-32 12) Antzelevitch C, Nof E: Brugada syndrome: Recent advances and controversies. Current Cardiology Reports 2008; 10: 376-383 22) Antzelevitch C: Late Potentials and the Brugada Syndrome. JACC 2002; 39: 1996-1999 2) Grande AD, Tabita V, Lizzio MM, et al: Early repolarization syndrome and Brugada syndrome: Is there any linkage? European Journal of Internal Medicine 2008; 19: 236-240 7) Ogawa M, Kumagai K, Yamanouchi Y, Saku K: Spontaneous onset of ventricular fibrillation in Brugada syndrome with J wave and STsegment elevation in the inferior leads. Heart Rhythm 2005; 2: 97-99 16) QT延長症候群 (先天性・二次性) とBrugada症候群の診療に関するガイドライン. Circ J 2007; 71: (Suppl) IV 19) Masaki R, Watanabe I, Nakai T, et al: Role of signal-averaged electrocardiograms for predicting the inducibility of ventricular fibrillation in the syndrome consisting of right bundle branch block and ST segment elevation in leads V1-V3. Jpn Heart J 2002; 43: 367-378 9) Ueyama T, Shimizu A, Esato M, et al: A case of a concealed type of Brugada syndrome with a J wave and mild ST-segment elevation in the inferolateral leads. Journal of Electrocardiology 2007; 40: 39-42 |
| References_xml | – reference: 1) Gussak I, Antzelevitch C: Early repolarization syndrome: clinical characteristics and possible cellular and ionic mechanisms. J Electrocardiol 2000; 33: 299-309 – reference: 6) Sahara M, Sagara K, Yamashita T, et al: J Wave and ST Segment Elevation in the Inferior Leads. Jpn Heart J 2002; 43: 55-60 – reference: 9) Ueyama T, Shimizu A, Esato M, et al: A case of a concealed type of Brugada syndrome with a J wave and mild ST-segment elevation in the inferolateral leads. Journal of Electrocardiology 2007; 40: 39-42 – reference: 13) Antzelevitch C: The Brugada syndrome: ionic basis and arrhythmia mechanisms. J Cardiovasc Electrophysiol 2001; 12: 268-272 – reference: 17) Junttila MJ, Brugada P, Hong K, et al: Differences in 12-Lead Electrocardiogram Between Symptomatic and Asymptomatic Brugada Syndrome Patients. J Cardiovasc Electrophysiol 2008; 19: 380-383 – reference: 19) Masaki R, Watanabe I, Nakai T, et al: Role of signal-averaged electrocardiograms for predicting the inducibility of ventricular fibrillation in the syndrome consisting of right bundle branch block and ST segment elevation in leads V1-V3. Jpn Heart J 2002; 43: 367-378 – reference: 20) Ohkubo K, Watanabe I, Takagi Y, et al: Endocardial Electrograms From the Right Ventricular Outflow Tract After Induced Ventricular Fibrillation in Patients With Brugada Syndrome. Circ J 2007; 71: 1258-1262 – reference: 22) Antzelevitch C: Late Potentials and the Brugada Syndrome. JACC 2002; 39: 1996-1999 – reference: 14) Gussak I, Antzelevitch C: Early Repolarization Syndrome: Clinical Characteristics and Possible Cellular and Ionic Mechanisms. Journal of Electrocardiology 2000; 33; 299-309 – reference: 10) Shu J, Zhu T, Yang L, et al: ST-segment elevation in the early repolarization syndrome, idiopathic ventricular fibrillation, and the Brugada syndrome: cellular and clinical linkage. J Electrocardiol 2005; 38: 26-32 – reference: 11) Brugada P, Brugada J: Right bundle branch block, persistent ST segment elevation and sudden cardiac death: A distinct clinical and electrocardiographic syndrome. J Am Coll Cardiol 1992; 20: 1391-1396 – reference: 12) Antzelevitch C, Nof E: Brugada syndrome: Recent advances and controversies. Current Cardiology Reports 2008; 10: 376-383 – reference: 23) Benito B, Brugada R, Brugada J Brugada P: Brugada syndrome. Progress in Cardiovascular Diseases 2008; 51: 1-22 – reference: 21) Nagase S, Kusano KF, Morita H, et al: Epicardial electrogram of the right ventricular outflow tract in patients with Brugada syndrome: using the epicardial lead. JACC 2002; 39: 1992-1995 – reference: 7) Ogawa M, Kumagai K, Yamanouchi Y, Saku K: Spontaneous onset of ventricular fibrillation in Brugada syndrome with J wave and STsegment elevation in the inferior leads. Heart Rhythm 2005; 2: 97-99 – reference: 18) Ikeda T, Sakurada H, Sakabe K, et al: Assessment of noninvasive markers in identifying patients at risk in the Brugada syndrome: Insight into risk stratification. J Am Coll Cardiol 2000; 37: 1628-1634 – reference: 3) Takagi M, Aihara N, Takaki H, et al: Clinical characteristics of patients with spontaneous or inducible ventricular fibrillation without apparent heart disease presenting with J wave and ST segment elevation in inferior leads. J Cardiovasc Electrophysiol 2000; 11: 844-846 – reference: 15) Yan G-X, Lankipalli RS, Burke JF, et al: Ventricular Repolarization Components on the Electrocardiogram Cellular Basis and Clinical Significance. J Am Coll Cardiol 2003; 42: 401-409 – reference: 5) Letsas KP, Efremidis M, Pappas LK, et al: Early repolarization syndrome: Is it always benign? International Journal of Cardiology 2007; 114: 390-392 – reference: 16) QT延長症候群 (先天性・二次性) とBrugada症候群の診療に関するガイドライン. Circ J 2007; 71: (Suppl) IV – reference: 2) Grande AD, Tabita V, Lizzio MM, et al: Early repolarization syndrome and Brugada syndrome: Is there any linkage? European Journal of Internal Medicine 2008; 19: 236-240 – reference: 4) Kalla H, Yan GX, Marinchak R: Ventricular fibrillation in a patient with prominent J (Osborn) waves and ST segment elevation in the inferior electrocardiographic leads: A Brugada syndrome variant? J Cardiovasc Electrophysiol 2000; 11: 95-98 – reference: 8) Ozeke O, Aras D, Celenk MK, et al: Exerciseinduced ventricular tachycardia associated with J point ST-segment elevation in inferior leads in a patient without apparent heart disease: a variant form of Brugada syndrome? Journal of Electrocardiology 2006; 39: 409-412 |
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| Snippet | 症例は40歳, 男性. 生来健康で健康診断は受けていなかった. 安静時に失神・痙攣しているところを家人が発見した. 救急隊現着時は心肺停止状態で, 心肺蘇生を行ったところ,... |
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| SubjectTerms | J wave syndrome ブルガダ症候群 心室細動 早期再分極症候群 突然死 |
| Title | 心肺停止から蘇生したIto-mediated J wave syndromeの1例 |
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