著明な除細動閾値高値を示した両室ペーシング機能付き植込み型除細動器導入の1例
症例は65歳, 男性.拡張型心筋症および慢性腎不全にて他院フオロー中であった, 2007年6月, 透析中に心室細動 (VF) を発症し電気的除細動で蘇生されたため, 植込み型除細動器の適応とされ当院へ紹介入院となった.著明な心拡大・心機能低下および心不全症状 (NYHAIII) を認めるため両室ペーシング機能付き植込み型除細動器 (CRT-D) 植込み術を施行した.同日に施行した除細動閾値 (DFT) テスト時に誘発されたVFは最大出力でも停止不能であり, 体外式除細動を要した.以後, 種々のプログラミング変更, 高出力デバイスへの交換, 皮下アレイ植込みなどを順次施行したが確実な除細動は得ら...
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| Published in | 心電図 Vol. 28; no. 1; pp. 68 - 75 |
|---|---|
| Main Authors | , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本不整脈心電学会
2008
日本心電学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1660 1884-2437 |
| DOI | 10.5105/jse.28.68 |
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| Abstract | 症例は65歳, 男性.拡張型心筋症および慢性腎不全にて他院フオロー中であった, 2007年6月, 透析中に心室細動 (VF) を発症し電気的除細動で蘇生されたため, 植込み型除細動器の適応とされ当院へ紹介入院となった.著明な心拡大・心機能低下および心不全症状 (NYHAIII) を認めるため両室ペーシング機能付き植込み型除細動器 (CRT-D) 植込み術を施行した.同日に施行した除細動閾値 (DFT) テスト時に誘発されたVFは最大出力でも停止不能であり, 体外式除細動を要した.以後, 種々のプログラミング変更, 高出力デバイスへの交換, 皮下アレイ植込みなどを順次施行したが確実な除細動は得られなかった.重症心不全に加え左上大静脈遺残による右側胸部植込み, アミオダロン内服などがDFT高値に関与したと考えられた.本症例は今後ますます増加が予想されるCRT-D症例における対処につき示唆に富むと考えられたため報告する. |
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| AbstractList | 症例は65歳, 男性.拡張型心筋症および慢性腎不全にて他院フオロー中であった, 2007年6月, 透析中に心室細動 (VF) を発症し電気的除細動で蘇生されたため, 植込み型除細動器の適応とされ当院へ紹介入院となった.著明な心拡大・心機能低下および心不全症状 (NYHAIII) を認めるため両室ペーシング機能付き植込み型除細動器 (CRT-D) 植込み術を施行した.同日に施行した除細動閾値 (DFT) テスト時に誘発されたVFは最大出力でも停止不能であり, 体外式除細動を要した.以後, 種々のプログラミング変更, 高出力デバイスへの交換, 皮下アレイ植込みなどを順次施行したが確実な除細動は得られなかった.重症心不全に加え左上大静脈遺残による右側胸部植込み, アミオダロン内服などがDFT高値に関与したと考えられた.本症例は今後ますます増加が予想されるCRT-D症例における対処につき示唆に富むと考えられたため報告する. 症例は65歳, 男性, 拡張型心筋症および慢性腎不全にて他院フォロー中であった. 2007年6月, 透析中に心室細動(VF)を発症し電気的除細動で蘇生されたため, 植込み型除細動器の適応とされ当院へ紹介入院となった. 著日月な心拡大・心機能低下および心不全症状(NYHA III)を認めるため両室ペーシング機能付き植込み型除細動器(CRT-D)植込み術を施行した. 同日に施行した除細動閾値(DFT)テスト時に誘発されたVFは最大出力でも停止不能であり, 体外式除細動を要した. 以後, 種々のプログラミング変更, 高出力デバイスへの交換, 皮下アレイ植込みなどを順次施行したが確実な除細動は得られなかった. 重症心不全に加え左上大静脈遺残による右側胸部植込み, アミオダロン内服などがDFT高値に関与したと考えられた. 本症例は今後ますます増加が予想されるCRT-D症例における対処につき示唆に富むと考えられたため報告する. 「I. はじめに」致死性心室性不整脈による心臓突然死予防として植込み型除細動器(ICD)の有効性はすでに種々の大規模臨床試験で示されている1)～3). |
| Author | 傅, 隆泰 朝田, 一生 相澤, 忠範 田邉, 大明 澤田, 準 御厨, 彰義 相良, 耕一 山下, 武志 山田, 純也 杉山, 裕章 大塚, 崇之 平野, 景子 |
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| References | 16) Schuger C, Ellenbogen KA, Faddis M, Knight BP, Yong P, Sample R; VENTAK CHF/CONTAK CD Study Investigators: Defibrillation energy requirements in an ICD population receiving cardiac resynchronization therapy. J Cardiovasc Electrophysiol, 2006; 17: 247-250 18) Freedman PA, Rasmussen MJ, Grice S, Trusty J, Glikson M, Stanton MS: Defibrillation thresholds are increased by right-sided implantation of totally transvenous implantable cardioverter defibrillators. Pacing Clin Electrophysiol, 1999; 22: 1186-1192 21) Flaker GC, Tummala R, Wilson J: Comparison of rightand left-sided pectoral implantation parameters with the Jewel active can cardiodefibrillator. The World Wide Jewel Investigators. Pacing Clin Electrophysiol, 1998; 21: 447-451 20) Kirk MM, Shorofsky SR, Gold MR: Comparison of the effects of active left and right pectoral pulse generators on defibrillation efficacy. Am J Cardiol, 2001; 88: 1308-1311 22) Hohnloser SH, Dorian P, Roberts R, Gent M, Israel CW, Fain E, Champagne J, Connolly SJ: Effect of amiodarone and sotalol on ventricular defibrillation threshold: the optimal pharmacological therapy in cardioverter defibrillator patients (OPTIC) trial. Circulation, 2006; 114: 104-109 8) Bardy GH, Ivey TD, Allen MD, Johnson G, Mehra R, Greene HL: A prospective randomized evaluation of biphasic versus monophasic waveform pulses on defibrillation efficacy in humans. J Am Coll Cardiol, 1989; 14: 728-733 9) Gold MR, Olsovsky MR, Pelini MA, Peters RW, Shorofsky SR: Comparison of single- and dual-coil active pectoral defibrillation lead systems. J Am Coll Cardiol, 1998; 31: 1391-1394 14) Shukla HH, Flaker GC, Jayam V, Roberts D : High defibrillation thresholds in transvenous biphasic implantable defibrillators: clinical predictors and prognostic implications. Pacing Clin Electrophysiol, 2003; 26: 44-48 7) Marchlinski FE, Flores B, Miller JM, Gottlieb CD, Hargrove WC 3rd: Relation of the intraoperative defibrillation threshold to successful postoperative defibrillation with an automatic implantable cardioverter defibrillator. Am J Cardiol, 1988; 62: 393-398 11) Raitt MH, Johnson G, Dolack GL, Poole JE, Kudenchuk PJ, Bardy GH: Clinical predictors of the defibrillation threshold with the unipolar implantable defibrillation system. J Am Coll Cardiol, 1995; 25: 1576-1583 19) Gold MR, Shih HT, Herre J, Breiter D, Zhang Y, Schwartz M; Low Energy Safety Study Investigators Comparison of defibrillation efficacy and survival associated with right versus left pectoral placement for implantable defibrillators. Am J Cardiol, 2007; 100: 243-246 10) Haffajee C, Martin D, Bhandari A, Bardy GH, DeSouza C, Kuehlkamp V, Church T: A multicenter, randomized trial comparing an active can implantable defibrillator with a passive can system. Jewel Active Can Investigators. Pacing Clin Electrophysiol, 1997; 20: 215-219 17) Epstein AE, Kay GN, Plumb VJ, Voshage-Stahl L, Hull ML: Elevated defibrillation threshold when right-sided venous access is used for nonthoracotomy implantable defibrillator lead implantation. The Endotak Investigators. J Cardiovasc Electrophysiol, 1995; 6 979-986 23) Gregoratos G, Abrams J, Epstein AE, Freedman RA, Hayes DL, Hlatky MA, Kerber RE, Naccarelli GV, Schoenfeld MH, Silka MJ, Winters SL, Gibbons RJ, Antman EM, Alpert JS, Gregoratos G, Hiratzka LF, Faxon DP, Jacobs AK, Fuster V, Smith SC Jr; American College of Cardiology American Heart Association Task Force on Practice Guidelines/North American Society for Pacing and Electrophysiology Committee to Update the 1998 Pacemaker Guidelines: ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: summary article: a report of the American College of Cardiology American Heart Association Task Force on Practice Guidelines (ACC /AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines) . Circulation, 2002; 106: 2145-2161 3) Connolly SJ, Hallstrom AP, Cappato R, Schron EB, Kuck KH, Zipes DP, Greene HL, Boczor S, Domanski M Follmann D, Gent M, Roberts RS: Meta-analysis of the implantable cardioverter defibrillator secondary prevention trials. AVID, CASH and CIDS studies. Antiarrhythmics vs Implantable Defibrillator study. Cardiac Arrest Study Hamburg. Canadian Implantable Defibrillator Study. Eur Heart J, 2000 ; 21: 2071-2078 1) Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML; Multicenter Automatic Defibrillator Implantation Trial II Investigators: Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med, 2002; 346: 877-883 2) Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, Domanski M, Troutman C, Anderson J, Johnson G, McNulty SE, Clapp-Channing N, DavidsonRay LD, Fraulo ES, Fishbein DP, Luceri RM, Ip JH; Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators: Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med, 2005; 352: 225-237 5) 日本循環器学会: 不整脈の非薬物治療ガイドライン (2006年改) . http: //plaza. umin. ac. jp/%7Ecirc/guideline JCS2006_kasanuki_h. pdf 13) Mainigi SK, Callans DJ: How to manage the patient with a high defibrillation threshold. Heart Rhythm, 2006; 3: 492-495 15) Russo AM, Sauer W, Gerstenfeld EP, Hsia HH, Lin D, Cooper JM, Dixit S, Verdino RJ, Nayak HM, Callans DJ, Patel V, Marchlinski FE: Defibrillation threshold testing: is it really necessary at the time of implantable cardioverter-defibrillator insertion? Heart Rhythm, 2005; 2: 456-461 12) Hodgson DM, Olsovsky MR, Shorofsky SR, Daly B, Gold MR: Clinical predictors of defibrillation thresholds with an active pectoral pulse generator lead system. Pacing Clin Electrophysiol, 2002; 25: 408-413 4) Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, DiCarlo L, DeMets D, White BG, DeVries DW, Feldman AM; Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators: Cardiacresynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med, 2004; 350: 2140-2150 6) Pelosi F Jr, Oral H, Kim MH, Sticherling C, Horwood L, Knight BP, Michaud GF, Morady F, Strickberger SA Effect of chronic amiodarone therapy on defibrillation energy requirements in humans. J Cardiovasc Electrophysiol, 2000; 11: 736-740 |
| References_xml | – reference: 16) Schuger C, Ellenbogen KA, Faddis M, Knight BP, Yong P, Sample R; VENTAK CHF/CONTAK CD Study Investigators: Defibrillation energy requirements in an ICD population receiving cardiac resynchronization therapy. J Cardiovasc Electrophysiol, 2006; 17: 247-250 – reference: 21) Flaker GC, Tummala R, Wilson J: Comparison of rightand left-sided pectoral implantation parameters with the Jewel active can cardiodefibrillator. The World Wide Jewel Investigators. Pacing Clin Electrophysiol, 1998; 21: 447-451 – reference: 3) Connolly SJ, Hallstrom AP, Cappato R, Schron EB, Kuck KH, Zipes DP, Greene HL, Boczor S, Domanski M Follmann D, Gent M, Roberts RS: Meta-analysis of the implantable cardioverter defibrillator secondary prevention trials. AVID, CASH and CIDS studies. Antiarrhythmics vs Implantable Defibrillator study. Cardiac Arrest Study Hamburg. Canadian Implantable Defibrillator Study. Eur Heart J, 2000 ; 21: 2071-2078 – reference: 10) Haffajee C, Martin D, Bhandari A, Bardy GH, DeSouza C, Kuehlkamp V, Church T: A multicenter, randomized trial comparing an active can implantable defibrillator with a passive can system. Jewel Active Can Investigators. Pacing Clin Electrophysiol, 1997; 20: 215-219 – reference: 20) Kirk MM, Shorofsky SR, Gold MR: Comparison of the effects of active left and right pectoral pulse generators on defibrillation efficacy. Am J Cardiol, 2001; 88: 1308-1311 – reference: 5) 日本循環器学会: 不整脈の非薬物治療ガイドライン (2006年改) . http: //plaza. umin. ac. jp/%7Ecirc/guideline JCS2006_kasanuki_h. pdf – reference: 23) Gregoratos G, Abrams J, Epstein AE, Freedman RA, Hayes DL, Hlatky MA, Kerber RE, Naccarelli GV, Schoenfeld MH, Silka MJ, Winters SL, Gibbons RJ, Antman EM, Alpert JS, Gregoratos G, Hiratzka LF, Faxon DP, Jacobs AK, Fuster V, Smith SC Jr; American College of Cardiology American Heart Association Task Force on Practice Guidelines/North American Society for Pacing and Electrophysiology Committee to Update the 1998 Pacemaker Guidelines: ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: summary article: a report of the American College of Cardiology American Heart Association Task Force on Practice Guidelines (ACC /AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines) . Circulation, 2002; 106: 2145-2161 – reference: 15) Russo AM, Sauer W, Gerstenfeld EP, Hsia HH, Lin D, Cooper JM, Dixit S, Verdino RJ, Nayak HM, Callans DJ, Patel V, Marchlinski FE: Defibrillation threshold testing: is it really necessary at the time of implantable cardioverter-defibrillator insertion? Heart Rhythm, 2005; 2: 456-461 – reference: 13) Mainigi SK, Callans DJ: How to manage the patient with a high defibrillation threshold. Heart Rhythm, 2006; 3: 492-495 – reference: 9) Gold MR, Olsovsky MR, Pelini MA, Peters RW, Shorofsky SR: Comparison of single- and dual-coil active pectoral defibrillation lead systems. J Am Coll Cardiol, 1998; 31: 1391-1394 – reference: 6) Pelosi F Jr, Oral H, Kim MH, Sticherling C, Horwood L, Knight BP, Michaud GF, Morady F, Strickberger SA Effect of chronic amiodarone therapy on defibrillation energy requirements in humans. J Cardiovasc Electrophysiol, 2000; 11: 736-740 – reference: 7) Marchlinski FE, Flores B, Miller JM, Gottlieb CD, Hargrove WC 3rd: Relation of the intraoperative defibrillation threshold to successful postoperative defibrillation with an automatic implantable cardioverter defibrillator. Am J Cardiol, 1988; 62: 393-398 – reference: 18) Freedman PA, Rasmussen MJ, Grice S, Trusty J, Glikson M, Stanton MS: Defibrillation thresholds are increased by right-sided implantation of totally transvenous implantable cardioverter defibrillators. Pacing Clin Electrophysiol, 1999; 22: 1186-1192 – reference: 22) Hohnloser SH, Dorian P, Roberts R, Gent M, Israel CW, Fain E, Champagne J, Connolly SJ: Effect of amiodarone and sotalol on ventricular defibrillation threshold: the optimal pharmacological therapy in cardioverter defibrillator patients (OPTIC) trial. Circulation, 2006; 114: 104-109 – reference: 4) Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, DiCarlo L, DeMets D, White BG, DeVries DW, Feldman AM; Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators: Cardiacresynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med, 2004; 350: 2140-2150 – reference: 14) Shukla HH, Flaker GC, Jayam V, Roberts D : High defibrillation thresholds in transvenous biphasic implantable defibrillators: clinical predictors and prognostic implications. Pacing Clin Electrophysiol, 2003; 26: 44-48 – reference: 19) Gold MR, Shih HT, Herre J, Breiter D, Zhang Y, Schwartz M; Low Energy Safety Study Investigators Comparison of defibrillation efficacy and survival associated with right versus left pectoral placement for implantable defibrillators. Am J Cardiol, 2007; 100: 243-246 – reference: 11) Raitt MH, Johnson G, Dolack GL, Poole JE, Kudenchuk PJ, Bardy GH: Clinical predictors of the defibrillation threshold with the unipolar implantable defibrillation system. J Am Coll Cardiol, 1995; 25: 1576-1583 – reference: 12) Hodgson DM, Olsovsky MR, Shorofsky SR, Daly B, Gold MR: Clinical predictors of defibrillation thresholds with an active pectoral pulse generator lead system. Pacing Clin Electrophysiol, 2002; 25: 408-413 – reference: 1) Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML; Multicenter Automatic Defibrillator Implantation Trial II Investigators: Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med, 2002; 346: 877-883 – reference: 8) Bardy GH, Ivey TD, Allen MD, Johnson G, Mehra R, Greene HL: A prospective randomized evaluation of biphasic versus monophasic waveform pulses on defibrillation efficacy in humans. J Am Coll Cardiol, 1989; 14: 728-733 – reference: 17) Epstein AE, Kay GN, Plumb VJ, Voshage-Stahl L, Hull ML: Elevated defibrillation threshold when right-sided venous access is used for nonthoracotomy implantable defibrillator lead implantation. The Endotak Investigators. J Cardiovasc Electrophysiol, 1995; 6 979-986 – reference: 2) Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, Domanski M, Troutman C, Anderson J, Johnson G, McNulty SE, Clapp-Channing N, DavidsonRay LD, Fraulo ES, Fishbein DP, Luceri RM, Ip JH; Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators: Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med, 2005; 352: 225-237 |
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| Snippet | 症例は65歳, 男性.拡張型心筋症および慢性腎不全にて他院フオロー中であった, 2007年6月, 透析中に心室細動 (VF) を発症し電気的除細動で蘇生されたため, 植込み型除細動... 症例は65歳, 男性, 拡張型心筋症および慢性腎不全にて他院フォロー中であった. 2007年6月, 透析中に心室細動(VF)を発症し電気的除細動で蘇生されたため, 植込み型除細動... |
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| SubjectTerms | 両室ペーシング機能付き植込み型除細動器 右側胸部植込み 心室細動 慢性心不全 除細動閾値 |
| Title | 著明な除細動閾値高値を示した両室ペーシング機能付き植込み型除細動器導入の1例 |
| URI | https://www.jstage.jst.go.jp/article/jse1981/28/1/28_1_68/_article/-char/ja http://mol.medicalonline.jp/library/journal/download?GoodsID=dn4eleca/2008/002801/010&name=0068-0075j |
| Volume | 28 |
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| ispartofPNX | 心電図, 2008/01/25, Vol.28(1), pp.68-75 |
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