A case of CTI depended macro-reentrant atrial tachycardia with very long cycle length and an isoelectric baseline between atrial deflections
症例は73歳, 女性. 洞不全症候群のため, ペースメーカ植込みを施行されていたが, 2002年心房頻拍(AT)と診断された. ATは誘発されるもすぐ心房細動(AF)に移行しマッピング困難であった. CARTOで作成したvoltage mapでは, 右心房に広範な低電位領域と瘢痕領域が存在していたが, チャネルの同定ができず, AF中の異常連続電位を指標に数カ所通電を加え終了した. 2010年, 動悸の頻度が増加し再度入院. 心臓電気生理学的検査では, AT1(CL 420msec)が誘発され, EnSiteのactivation mapで右心房中隔に最早期興奮部位を認め同部位の通電でAT1は...
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| Published in | Shinzo Vol. 43; no. SUPPL.3; pp. S3_61 - S3_67 |
|---|---|
| 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_61 |
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| Abstract | 症例は73歳, 女性. 洞不全症候群のため, ペースメーカ植込みを施行されていたが, 2002年心房頻拍(AT)と診断された. ATは誘発されるもすぐ心房細動(AF)に移行しマッピング困難であった. CARTOで作成したvoltage mapでは, 右心房に広範な低電位領域と瘢痕領域が存在していたが, チャネルの同定ができず, AF中の異常連続電位を指標に数カ所通電を加え終了した. 2010年, 動悸の頻度が増加し再度入院. 心臓電気生理学的検査では, AT1(CL 420msec)が誘発され, EnSiteのactivation mapで右心房中隔に最早期興奮部位を認め同部位の通電でAT1は停止した. その後AT2(CL 545msec)が誘発され, 右心耳基部に最早期興奮部位を認め, 同部位の通電で誘発されなくなった. さらにAT3(CL 570msec)が誘発された. CARTOのactivation mapでは三尖弁輪を反時計方向回転に旋回しており右房峡部でpost pacing intervalがCLと一致したため, 右房峡部に線状通電を行ったところ, 通電中にAT3は停止し誘発されなくなった. 通常型心房粗動のCLは200msec前後であることが多い. 本症例のように570msecという長いCLを持った頻拍が三尖弁輪上を興奮旋回することは稀と考えられたので報告する. |
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| AbstractList | 症例は73歳, 女性. 洞不全症候群のため, ペースメーカ植込みを施行されていたが, 2002年心房頻拍(AT)と診断された. ATは誘発されるもすぐ心房細動(AF)に移行しマッピング困難であった. CARTOで作成したvoltage mapでは, 右心房に広範な低電位領域と瘢痕領域が存在していたが, チャネルの同定ができず, AF中の異常連続電位を指標に数カ所通電を加え終了した. 2010年, 動悸の頻度が増加し再度入院. 心臓電気生理学的検査では, AT1(CL 420msec)が誘発され, EnSiteのactivation mapで右心房中隔に最早期興奮部位を認め同部位の通電でAT1は停止した. その後AT2(CL 545msec)が誘発され, 右心耳基部に最早期興奮部位を認め, 同部位の通電で誘発されなくなった. さらにAT3(CL 570msec)が誘発された. CARTOのactivation mapでは三尖弁輪を反時計方向回転に旋回しており右房峡部でpost pacing intervalがCLと一致したため, 右房峡部に線状通電を行ったところ, 通電中にAT3は停止し誘発されなくなった. 通常型心房粗動のCLは200msec前後であることが多い. 本症例のように570msecという長いCLを持った頻拍が三尖弁輪上を興奮旋回することは稀と考えられたので報告する. |
| Author | Hiratsuka, Atsushi Shimizu, Akihiko Yoshida, Masaaki Ueyama, Takeshi Doi, Masahiro Fukuda, Masakazu Oomiya, Toshihide Kato, Takayoshi Matsuzaki, Masunori |
| Author_FL | 土居 正浩 福田 昌和 平塚 淳史 清水 昭彦 上山 剛 大宮 俊秀 松崎 益徳 吉田 吉田雅昭 加藤 孝佳 |
| Author_FL_xml | – sequence: 1 fullname: 平塚 淳史 – sequence: 2 fullname: 清水 昭彦 – sequence: 3 fullname: 上山 剛 – sequence: 4 fullname: 土居 正浩 – sequence: 5 fullname: 大宮 俊秀 – sequence: 6 fullname: 吉田 吉田雅昭 – sequence: 7 fullname: 福田 昌和 – sequence: 8 fullname: 加藤 孝佳 – sequence: 9 fullname: 松崎 益徳 |
| Author_xml | – sequence: 1 fullname: Fukuda, Masakazu organization: Division of Cardiology, Yamaguchi University Graduate School of Medicine – sequence: 1 fullname: Yoshida, Masaaki organization: Division of Cardiology, Yamaguchi University Graduate School of Medicine – sequence: 1 fullname: Kato, Takayoshi organization: Division of Cardiology, Yamaguchi University Graduate School of Medicine – sequence: 1 fullname: Matsuzaki, Masunori organization: Division of Cardiology, Yamaguchi University Graduate School of Medicine – sequence: 1 fullname: Ueyama, Takeshi organization: Division of Cardiology, Yamaguchi University Graduate School of Medicine – sequence: 1 fullname: Doi, Masahiro organization: Division of Cardiology, Yamaguchi University Graduate School of Medicine – sequence: 1 fullname: Shimizu, Akihiko organization: Division of Cardiology, Yamaguchi University Graduate School of Medicine – sequence: 1 fullname: Oomiya, Toshihide organization: Division of Cardiology, Yamaguchi University Graduate School of Medicine – sequence: 1 fullname: Hiratsuka, Atsushi organization: Division of Cardiology, Yamaguchi University Graduate School of Medicine |
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| DocumentTitleAlternate | 非常に長い興奮周期(570ms) で三尖弁輪周囲を旋回したため心房頻拍様心電図を示したマクロリエントリー性頻拍の1例 |
| DocumentTitle_FL | 非常に長い興奮周期(570ms) で三尖弁輪周囲を旋回したため心房頻拍様心電図を示したマクロリエントリー性頻拍の1例 |
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| References | 5) Stambler BS, et al: Pharmacologic alterations in human type I atrial flutter cycle length and monophasic action potential duration. Evidence of a fully excitable gap in the reentrant circuit. J Am Coll Cardiol 1996; 27: 453-461 2) Olshansky B, Okumura K, Hess PG, et al: Demonstration of an area of slow conduction in human atrial flutter. J Am Coll Cardiol 1990; 16: 1639-1648 1) Lee KW, et al: Atrial flutter: a review of its history, mechanisms, clinical features, and current therapy. Curr probl Cardiol 2005; 30: 121-168 6) Jie Cheng, et al: Electrophysiological response of the right atrium to ibutilide during typical atrial flutter. Circulation 2002; 106: 814-819 3) Tai CT, Chen SA, Chiang CE, et al. Characterization of low right atrial isthmus as the slow conduction zone and pharmacological target in typical atrial flutter. Circulation 1997; 96: 2601-2611 4) Feld GK, Mollerus M, Birgersdotter-Green U, et al. Conduction velocity in the tricuspid valve-inferior vena cava isthmus is slower in patients with type I atrial flutter compared to those without a history of atrial flutter. J Cardiovasc Electrophysiol 1997; 8: 1338-1348 |
| References_xml | – reference: 1) Lee KW, et al: Atrial flutter: a review of its history, mechanisms, clinical features, and current therapy. Curr probl Cardiol 2005; 30: 121-168 – reference: 6) Jie Cheng, et al: Electrophysiological response of the right atrium to ibutilide during typical atrial flutter. Circulation 2002; 106: 814-819 – reference: 3) Tai CT, Chen SA, Chiang CE, et al. Characterization of low right atrial isthmus as the slow conduction zone and pharmacological target in typical atrial flutter. Circulation 1997; 96: 2601-2611 – reference: 2) Olshansky B, Okumura K, Hess PG, et al: Demonstration of an area of slow conduction in human atrial flutter. J Am Coll Cardiol 1990; 16: 1639-1648 – reference: 5) Stambler BS, et al: Pharmacologic alterations in human type I atrial flutter cycle length and monophasic action potential duration. Evidence of a fully excitable gap in the reentrant circuit. J Am Coll Cardiol 1996; 27: 453-461 – reference: 4) Feld GK, Mollerus M, Birgersdotter-Green U, et al. Conduction velocity in the tricuspid valve-inferior vena cava isthmus is slower in patients with type I atrial flutter compared to those without a history of atrial flutter. J Cardiovasc Electrophysiol 1997; 8: 1338-1348 |
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| Snippet | 症例は73歳, 女性. 洞不全症候群のため, ペースメーカ植込みを施行されていたが, 2002年心房頻拍(AT)と診断された. ATは誘発されるもすぐ心房細動(AF)に移行しマッピング困難であった. CARTOで作成したvoltage mapでは, 右心房に広範な低電位領域と瘢痕領域が存在していたが,... |
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| SubjectTerms | リエントリー性頻拍 三尖弁輪下大静脈峡部 心房粗動 心房頻拍 心臓電気生理学的検査 |
| Title | A case of CTI depended macro-reentrant atrial tachycardia with very long cycle length and an isoelectric baseline between atrial deflections |
| URI | https://www.jstage.jst.go.jp/article/shinzo/43/SUPPL.3/43_S3_61/_article/-char/en https://cir.nii.ac.jp/crid/1390282679026308352 |
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