専門医から学ぶ不整脈の臨床 早期再分極症候群の意義と臨床
早期再分極の主要所見であるJ波は2誘導以上においてJ点が基線より0.1mV以上，ST上昇は基線より0.1mV以上とされる．古くから知られておりこれまで予後は良好とみなされてきた．Brugada症候群が確立されるとこれとは異なり，J波を示す特発性心室細動が報告された．2008年に入り早期再分極と特発性心室細動または心臓突然死との関連がほぼ確定的になった．J波は一般集団の10%前後に見られ若い男性に多い．低体温，麻酔後，虚血，電解質異常などでも出現する．著明（>0.2mV）なもの，下壁誘導を中心に広範に見られるものなどは危険とされる．J波と心室細動の抑制にはイソプロテレノールやキニジンが有効...
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| Published in | 日本臨床麻酔学会誌 Vol. 31; no. 7; pp. 910 - 915 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床麻酔学会
2011
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-4945 1349-9149 |
| DOI | 10.2199/jjsca.31.910 |
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| Abstract | 早期再分極の主要所見であるJ波は2誘導以上においてJ点が基線より0.1mV以上，ST上昇は基線より0.1mV以上とされる．古くから知られておりこれまで予後は良好とみなされてきた．Brugada症候群が確立されるとこれとは異なり，J波を示す特発性心室細動が報告された．2008年に入り早期再分極と特発性心室細動または心臓突然死との関連がほぼ確定的になった．J波は一般集団の10%前後に見られ若い男性に多い．低体温，麻酔後，虚血，電解質異常などでも出現する．著明（>0.2mV）なもの，下壁誘導を中心に広範に見られるものなどは危険とされる．J波と心室細動の抑制にはイソプロテレノールやキニジンが有効である． |
|---|---|
| AbstractList | 早期再分極の主要所見であるJ波は2誘導以上においてJ点が基線より0.1mV以上，ST上昇は基線より0.1mV以上とされる．古くから知られておりこれまで予後は良好とみなされてきた．Brugada症候群が確立されるとこれとは異なり，J波を示す特発性心室細動が報告された．2008年に入り早期再分極と特発性心室細動または心臓突然死との関連がほぼ確定的になった．J波は一般集団の10%前後に見られ若い男性に多い．低体温，麻酔後，虚血，電解質異常などでも出現する．著明（>0.2mV）なもの，下壁誘導を中心に広範に見られるものなどは危険とされる．J波と心室細動の抑制にはイソプロテレノールやキニジンが有効である． [要旨] 早期再分極の主要所見であるJ波は2誘導以上においてJ点が基線より0.1mV以上, ST上昇は基線より0.1mV以上とされる. 古くから知られておりこれまで予後は良好とみなされてきた. Brugada症候群が確立されるとこれとは異なり, J波を示す特発性心室細動が報告された. 2008年に入り早期再分極と特発性心室細動または心臓突然死との関連がほぼ確定的になった. J波は一般集団の10％前後に見られ若い男性に多い. 低体温, 麻酔後, 虚血, 電解質異常などでも出現する. 著明（＞0.2mV）なもの, 下壁誘導を中心に広範に見られるものなどは危険とされる. J波と心室細動の抑制にはイソプロテレノールやキニジンが有効である. 「はじめに」心筋の再分極相は脱分極が完了した0相直後から, プラトー相および3相を得て静止膜電位に戻るまでが相当する. 早期再分極第1相のノッチが見られる心外膜側に始まりこれは心電図のJ点に一致する. |
| Author | 相澤, 義房 |
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| References | 4) Littman D: Persistence of the juvenile pattern in precordial leads of healthy adult Negroes with a report of electrocardiographic survey on 300 Negro and 200 white subjects. Am Heart J 32: 370-382, 1946 1) Yan GX, Antzelevitch C: Cellular basis for the electrocardiographic J wave. Circulation 93: 372-379, 1996 5) Wasserburger RH, Alt WJ: The normal RS-T segment elevation variant. Am J Cardiol 8: 184-192, 1961 24) Shinohara T, Takahashi N, Saikawa T, et al.: Characterization of J wave in a patient with idiopathic ventricular fibrillation. Heart Rhythm 3: 1082-1084, 2006 20) Nagao S, Hayashi Y, Yagihara N, et al.: Preexcitation unmasks J waves: 2 cases. J Electrocardiol 44: 359-362, 2011 15) Jastrzebski M, Kukla P: Ischemic J wave: novel risk marker for ventricular fibrillation? Heart Rhythm 6: 829-835, 2009 25) Nam GB, Ko KH, Kim J, et al.: Mode of onset of ventricular fibrillation in patients with early repolarization pattern vs. Brugada syndrome. Eur Heart J 31: 330-339, 2010 9) Aizawa Y, Tamura M, Chinushi M, et al.: An attempt at electrical catheter ablation of the arrhythmogenic area in idiopathic ventricular fibrillation. Am Heart J 123: 257-260, 1992 19) Horigome H, Shigeta O, Kuga K, et al.: Ventricular fibrillation during anesthesia in association with J waves in the left precordial leads in a child with coarctation of the aorta. J Electrocardiol 36: 339-343, 2003 26) Antzelevitch C, Yan GX: J wave syndromes. Heart Rhythm 7: 549-558, 2010 3) Shipley RA, Hallaran WR: The four lead electrocardiogram in 200 normal men and women. Am Heart J 11: 325-345, 1936 23) Yan GX, Joshi A, Guo D, et al.: Phase 2 reentry as a trigger to initiate ventricular fibrillation during early acute myocardial ischemia. Circulation 110: 1036-1041, 2004 12) Rosso R, Kogan E, Belhassen B, et al.: J-point elevation in survivors of primary ventricular fibrillation and matched control subjects: incidence and clinical significance. J Am Coll Cardiol 52: 1231-1238, 2008 7) Klatsky AL, Oehm R, Cooper RA, et al.: The early repolarization normal variant electrocardiogram: correlates and consequences. Am J Med 115: 171-177, 2003 18) Hersch C: Electrocardiographic changes in head injuries. Circulation 23: 853-860, 1961 6) Kambara H, Phillips J: Long-term evaluation of early repolarization syndrome (normal variant RS-T segment elevation). Am J Cardiol 38: 157-161, 1976 10) Aizawa Y, Tamura M, Chinushi M, et al.: Idiopathic ventricular fibrillation and bradycardia-dependent intraventricular block. Am Heart J 126: 1473-1474, 1993 14) Osborn JJ: Experimental hypothermia: respiratory and blood pH changes in relation to cardiac function. Am J Physiol 175: 389-398, 1953 22) 佐藤光希，池主雅臣，八木原伸江ほか：成人におけるJ波の頻度とその特徴─外来症例における検討─．心電図 2011（印刷中） 8) Hayashi M, Murata M, Aizawa Y, et al.: Sudden nocturnal death in young males from ventricular flutter. Jpn Heart J 26: 585-591, 1985 16) Yagihara N, Sato A, Furushima H, et al.: Ischemia-induced prominent J waves in a patient with Brugada syndrome. Intern Med 49: 1979-1982, 2010 21) Kui C, Congxin H, Xi W, et al.: Characteristic of the prevalence of J wave in apparently healthy Chinese adults. Arch Med Res 39: 232-235, 2008 17) Topsakal R, Saglam H, ArinÇ H, et al.: Electrocardiographic J wave as a result of hypercalcemia aggravated by thiazide diuretics in a case of primary hyperparathyroidism. Jpn Heart J 44: 1033-1037, 2003 11) Haïssaguerre M, Derval N, Sacher F, et al.: Sudden cardiac arrest associated with early repolarization. N Engl J Med 358: 2016-2023, 2008 13) Tikkanen JT, Anttonen O, Junttila MJ, et al.: Long-term outcome associated with early repolarization on electrocardiography. N Engl J Med 361: 2529-2537, 2009 2) Brugada P, Brugada J: Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol 20: 1391-1396, 1992 |
| References_xml | – reference: 23) Yan GX, Joshi A, Guo D, et al.: Phase 2 reentry as a trigger to initiate ventricular fibrillation during early acute myocardial ischemia. Circulation 110: 1036-1041, 2004 – reference: 8) Hayashi M, Murata M, Aizawa Y, et al.: Sudden nocturnal death in young males from ventricular flutter. Jpn Heart J 26: 585-591, 1985 – reference: 10) Aizawa Y, Tamura M, Chinushi M, et al.: Idiopathic ventricular fibrillation and bradycardia-dependent intraventricular block. Am Heart J 126: 1473-1474, 1993 – reference: 2) Brugada P, Brugada J: Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol 20: 1391-1396, 1992 – reference: 26) Antzelevitch C, Yan GX: J wave syndromes. Heart Rhythm 7: 549-558, 2010 – reference: 6) Kambara H, Phillips J: Long-term evaluation of early repolarization syndrome (normal variant RS-T segment elevation). Am J Cardiol 38: 157-161, 1976 – reference: 19) Horigome H, Shigeta O, Kuga K, et al.: Ventricular fibrillation during anesthesia in association with J waves in the left precordial leads in a child with coarctation of the aorta. J Electrocardiol 36: 339-343, 2003 – reference: 24) Shinohara T, Takahashi N, Saikawa T, et al.: Characterization of J wave in a patient with idiopathic ventricular fibrillation. Heart Rhythm 3: 1082-1084, 2006 – reference: 11) Haïssaguerre M, Derval N, Sacher F, et al.: Sudden cardiac arrest associated with early repolarization. N Engl J Med 358: 2016-2023, 2008 – reference: 13) Tikkanen JT, Anttonen O, Junttila MJ, et al.: Long-term outcome associated with early repolarization on electrocardiography. N Engl J Med 361: 2529-2537, 2009 – reference: 4) Littman D: Persistence of the juvenile pattern in precordial leads of healthy adult Negroes with a report of electrocardiographic survey on 300 Negro and 200 white subjects. Am Heart J 32: 370-382, 1946 – reference: 12) Rosso R, Kogan E, Belhassen B, et al.: J-point elevation in survivors of primary ventricular fibrillation and matched control subjects: incidence and clinical significance. J Am Coll Cardiol 52: 1231-1238, 2008 – reference: 17) Topsakal R, Saglam H, ArinÇ H, et al.: Electrocardiographic J wave as a result of hypercalcemia aggravated by thiazide diuretics in a case of primary hyperparathyroidism. Jpn Heart J 44: 1033-1037, 2003 – reference: 18) Hersch C: Electrocardiographic changes in head injuries. Circulation 23: 853-860, 1961 – reference: 22) 佐藤光希，池主雅臣，八木原伸江ほか：成人におけるJ波の頻度とその特徴─外来症例における検討─．心電図 2011（印刷中） – reference: 25) Nam GB, Ko KH, Kim J, et al.: Mode of onset of ventricular fibrillation in patients with early repolarization pattern vs. Brugada syndrome. Eur Heart J 31: 330-339, 2010 – reference: 21) Kui C, Congxin H, Xi W, et al.: Characteristic of the prevalence of J wave in apparently healthy Chinese adults. Arch Med Res 39: 232-235, 2008 – reference: 15) Jastrzebski M, Kukla P: Ischemic J wave: novel risk marker for ventricular fibrillation? Heart Rhythm 6: 829-835, 2009 – reference: 9) Aizawa Y, Tamura M, Chinushi M, et al.: An attempt at electrical catheter ablation of the arrhythmogenic area in idiopathic ventricular fibrillation. Am Heart J 123: 257-260, 1992 – reference: 3) Shipley RA, Hallaran WR: The four lead electrocardiogram in 200 normal men and women. Am Heart J 11: 325-345, 1936 – reference: 7) Klatsky AL, Oehm R, Cooper RA, et al.: The early repolarization normal variant electrocardiogram: correlates and consequences. Am J Med 115: 171-177, 2003 – reference: 20) Nagao S, Hayashi Y, Yagihara N, et al.: Preexcitation unmasks J waves: 2 cases. J Electrocardiol 44: 359-362, 2011 – reference: 16) Yagihara N, Sato A, Furushima H, et al.: Ischemia-induced prominent J waves in a patient with Brugada syndrome. Intern Med 49: 1979-1982, 2010 – reference: 1) Yan GX, Antzelevitch C: Cellular basis for the electrocardiographic J wave. Circulation 93: 372-379, 1996 – reference: 14) Osborn JJ: Experimental hypothermia: respiratory and blood pH changes in relation to cardiac function. Am J Physiol 175: 389-398, 1953 – reference: 5) Wasserburger RH, Alt WJ: The normal RS-T segment elevation variant. Am J Cardiol 8: 184-192, 1961 |
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| Snippet | 早期再分極の主要所見であるJ波は2誘導以上においてJ点が基線より0.1mV以上，ST上昇は基線より0.1mV以上とされる．古くから知られておりこれまで予後は良... [要旨] 早期再分極の主要所見であるJ波は2誘導以上においてJ点が基線より0.1mV以上, ST上昇は基線より0.1mV以上とされる. 古くから知られておりこれまで予後は良... |
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| SubjectTerms | Brugada syndrome Early repolarization Idiopathic ventricular fibrillation J wave J波 ブルガダ症候群 早期再分極 特発性心室細動 |
| Title | 専門医から学ぶ不整脈の臨床 早期再分極症候群の意義と臨床 |
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