ブルガダ症候群における心室細動易誘発性と右室流出路単相性活動電位持続時間回復特性の関連 対照群との比較検討
ブルガダ症候群 (BS) における心室細動 (VF) の発生機序として，右室流出路心筋活動電位波形の第 1 相の増強とそれに続く活動電位ドームの減高，消失に基 づく phase 2 reentry が注目されている．我々は BS と対照群に対し右室流出路 (RVOT) で単相性活動電位を記 録し，有効不応期 (ERP) および心筋活動電位持続時間 (MAPD) の回復特性について検討を行った．対象は電気生理学的検査で 3 連早期刺激までで VF が誘発された BS 9 例および対照群 8 例．基本周期刺激時における MAPDは 2 群間で有意差がなかった．しかし ERP および最短拡張期間隔に...
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| Published in | 日大医学雑誌 Vol. 67; no. 5; pp. 293 - 298 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本大学医学会
01.10.2008
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0029-0424 1884-0779 |
| DOI | 10.4264/numa.67.293 |
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| Abstract | ブルガダ症候群 (BS) における心室細動 (VF) の発生機序として，右室流出路心筋活動電位波形の第 1 相の増強とそれに続く活動電位ドームの減高，消失に基 づく phase 2 reentry が注目されている．我々は BS と対照群に対し右室流出路 (RVOT) で単相性活動電位を記 録し，有効不応期 (ERP) および心筋活動電位持続時間 (MAPD) の回復特性について検討を行った．対象は電気生理学的検査で 3 連早期刺激までで VF が誘発された BS 9 例および対照群 8 例．基本周期刺激時における MAPDは 2 群間で有意差がなかった．しかし ERP および最短拡張期間隔における MAPD は BS で有意に短縮していた．また MAPD 回復曲線より算出された最大の傾き (slope max) は BS の方が急峻の傾向を示した．以上より，RVOT における心室早期刺激時の MAPD の短縮および slope max の急峻化が BS の VF 発生に関与していると考えられた． |
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| AbstractList | ブルガダ症候群 (BS) における心室細動 (VF) の発生機序として，右室流出路心筋活動電位波形の第 1 相の増強とそれに続く活動電位ドームの減高，消失に基 づく phase 2 reentry が注目されている．我々は BS と対照群に対し右室流出路 (RVOT) で単相性活動電位を記 録し，有効不応期 (ERP) および心筋活動電位持続時間 (MAPD) の回復特性について検討を行った．対象は電気生理学的検査で 3 連早期刺激までで VF が誘発された BS 9 例および対照群 8 例．基本周期刺激時における MAPDは 2 群間で有意差がなかった．しかし ERP および最短拡張期間隔における MAPD は BS で有意に短縮していた．また MAPD 回復曲線より算出された最大の傾き (slope max) は BS の方が急峻の傾向を示した．以上より，RVOT における心室早期刺激時の MAPD の短縮および slope max の急峻化が BS の VF 発生に関与していると考えられた． |
| Author | 芦野, 園子 平山, 篤志 中井, 俊子 小船, 雅義 奥村, 恭男 大久保, 公恵 渡辺, 一郎 |
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| References | 1) Brugada P, Brugada J. Right bundle branch block, persistent ST segment elevation and sudden cardiac death. J Am Coll Cardiol 1992; 20: 1391-1396. 11) Masaki R, Watanabe I, Nakai T, et al. Role of signal-averaged electrocardiograms for predicting the inducibility of ventricular fibrillation the syndrome consisting of right bundle branch block and ST segment elevation in leads V1-V3. JPN Heart J 2002; 43: 367-378. 23) Chinushi M, Washizuka T, Chinushi Y, et al. Induction of ventricular fibrillation in Brugada syndrome by site-specific right ventricular premature depolarization. Pacing Clin Electro-physiol 2002; 25: 1649-1651. 12) Moore HJ, Franz MR. Monophasic action potential recordings in humans. J Cardiovasc Electrophysiol 2007; 18: 787-790. 3) Prioi SG, Napolitano C, Gaspsrini M, et al. Natural history of Brugada syndrome: insights for risk stratification and management. Circulation 2002; 105: 1342-1347. 9) Wilde AAM, Antzelevitch C, Borggrefe, et al. Proposed diagnostic criteria for the Brugada syndrome: Consensus report. Circulation 2002; 106: 2514-2519. 16) Koller ML, Maier SKG, Gelzer AR, et al. Altered dynamics of action potential resitution and alternans in humans with structural heart disease. Circulation 2005; 112: 1542-1548. 4) Yan GX, Antzelevitch C. Cellular basis for the electrocardiographic J wave. Circulation 1996; 93: 372-379. 7) Kimura M, Kobayashi T, Owada S, et al. Mechanism of ST elevation and ventricular arrhythmias in an experimental Brugada syndrome model. Circulation 2004; 109: 125-131. 2) Brugada J, Brugada R, Antzelevitch C, et al. Long-term follow-up of individuals with the electrocardiographic pattern of right bundle-branch block and ST-segment elevation in precordial leads V1 to V3. Circulation 2002; 105: 73-78. 5) Yan GX, Antzelevitch C. Cellular basis for Brugada syndrome and other mechanisms of arrhythmogenesis associated with ST-segment elevation. Circulation 1999; 100: 1660-1666. 20) Hayashi M, Takatsuki S, Maison-Blanche P, et al. Ventricular repolarization restitution properties in patients exhibiting Type 1 Brugada electrocardiogram with and without inducible ventricular fibrillation. J Am Coll Cardiol 2008; 51: 1162-1168. 6) Lukas A, Antzelevitch C. Phase 2 reentry as a mechanism of initiation of circus movement reentry in canine epicardium exposed to simulated ischemia: the antiarrhythmic effects of 4-aminopyridine. Cardiovasc Res 1996; 32: 593-603. 17) Garfinkel A, Kim YH, Voroshilovsky O, et al. Preventing ventricular fibrillation by flattening cardiac restitution. Proc Natl Acad Sci USA 2000; 97: 6061-6066. 10) Shimizu W, Antzelevitch C, Suyama K, et al. Effect of sodium channel blockers on ST segment, QRS duration, and corrected QT interval in patients with Brugada syndrome. J Cardiovasc Electrophysiol 2000; 11: 1320-1329. 18) Nolasco JB, Dahlen RW. A graphic method for the study of alternation in cardiac action potentials. J Appl Physiol 1968; 25: 191-196. 8) Ideker RE, Rogers JM, Gray RA. Steepness of the restitution curve: A slippery slope? J Cardiovasc Electrophysiol 2002; 13: 1173-1175. 15) Walker ML, Rosenbaum DS. Cellular alternans as mechanism of cardiac arrhythmogenesis. Heart Rhythm 2005; 2: 1383-1386. 21) Narayan SM, Kim J, Tate C, et al. Steep restitution of ventricular action potential duration and conduction slowing in human Brugada syndrome. Heart Rhythm 2007; 4: 1087-1089. 22) Morita H, Fukushima-Kusano K, Nagase S, et al. Site-specific arrhythmogenesis in patients Brugada syndrome. J Cardiovasc Electrophysiol 2003; 14: 373-379. 14) Weiss JN, Karma A, Shiferaw Y, et al. From pulsus to pulse-less: the saga of cardiac alternans. Circ Res 2006; 98: 1244. 19) Pak HN, Hong SJ, Hwang GS, et al. Spatial dispersion of action potential duration restitution kinetics is associated with induction of ventricular tachycardia/ fibrillation in humans. J Cardio-vasc Electrophysiol 2004; 15: 1357-1363. 13) Bass BG. Restitution of the action potential in cat papillary muscle. Am J Physiol 1975; 228: 1717-1724. |
| References_xml | – reference: 21) Narayan SM, Kim J, Tate C, et al. Steep restitution of ventricular action potential duration and conduction slowing in human Brugada syndrome. Heart Rhythm 2007; 4: 1087-1089. – reference: 8) Ideker RE, Rogers JM, Gray RA. Steepness of the restitution curve: A slippery slope? J Cardiovasc Electrophysiol 2002; 13: 1173-1175. – reference: 17) Garfinkel A, Kim YH, Voroshilovsky O, et al. Preventing ventricular fibrillation by flattening cardiac restitution. Proc Natl Acad Sci USA 2000; 97: 6061-6066. – reference: 11) Masaki R, Watanabe I, Nakai T, et al. Role of signal-averaged electrocardiograms for predicting the inducibility of ventricular fibrillation the syndrome consisting of right bundle branch block and ST segment elevation in leads V1-V3. JPN Heart J 2002; 43: 367-378. – reference: 3) Prioi SG, Napolitano C, Gaspsrini M, et al. Natural history of Brugada syndrome: insights for risk stratification and management. Circulation 2002; 105: 1342-1347. – reference: 7) Kimura M, Kobayashi T, Owada S, et al. Mechanism of ST elevation and ventricular arrhythmias in an experimental Brugada syndrome model. Circulation 2004; 109: 125-131. – reference: 18) Nolasco JB, Dahlen RW. A graphic method for the study of alternation in cardiac action potentials. J Appl Physiol 1968; 25: 191-196. – reference: 22) Morita H, Fukushima-Kusano K, Nagase S, et al. Site-specific arrhythmogenesis in patients Brugada syndrome. J Cardiovasc Electrophysiol 2003; 14: 373-379. – reference: 12) Moore HJ, Franz MR. Monophasic action potential recordings in humans. J Cardiovasc Electrophysiol 2007; 18: 787-790. – reference: 19) Pak HN, Hong SJ, Hwang GS, et al. Spatial dispersion of action potential duration restitution kinetics is associated with induction of ventricular tachycardia/ fibrillation in humans. J Cardio-vasc Electrophysiol 2004; 15: 1357-1363. – reference: 1) Brugada P, Brugada J. Right bundle branch block, persistent ST segment elevation and sudden cardiac death. J Am Coll Cardiol 1992; 20: 1391-1396. – reference: 16) Koller ML, Maier SKG, Gelzer AR, et al. Altered dynamics of action potential resitution and alternans in humans with structural heart disease. Circulation 2005; 112: 1542-1548. – reference: 9) Wilde AAM, Antzelevitch C, Borggrefe, et al. Proposed diagnostic criteria for the Brugada syndrome: Consensus report. Circulation 2002; 106: 2514-2519. – reference: 14) Weiss JN, Karma A, Shiferaw Y, et al. From pulsus to pulse-less: the saga of cardiac alternans. Circ Res 2006; 98: 1244. – reference: 6) Lukas A, Antzelevitch C. Phase 2 reentry as a mechanism of initiation of circus movement reentry in canine epicardium exposed to simulated ischemia: the antiarrhythmic effects of 4-aminopyridine. Cardiovasc Res 1996; 32: 593-603. – reference: 20) Hayashi M, Takatsuki S, Maison-Blanche P, et al. Ventricular repolarization restitution properties in patients exhibiting Type 1 Brugada electrocardiogram with and without inducible ventricular fibrillation. J Am Coll Cardiol 2008; 51: 1162-1168. – reference: 4) Yan GX, Antzelevitch C. Cellular basis for the electrocardiographic J wave. Circulation 1996; 93: 372-379. – reference: 5) Yan GX, Antzelevitch C. Cellular basis for Brugada syndrome and other mechanisms of arrhythmogenesis associated with ST-segment elevation. Circulation 1999; 100: 1660-1666. – reference: 13) Bass BG. Restitution of the action potential in cat papillary muscle. Am J Physiol 1975; 228: 1717-1724. – reference: 15) Walker ML, Rosenbaum DS. Cellular alternans as mechanism of cardiac arrhythmogenesis. Heart Rhythm 2005; 2: 1383-1386. – reference: 2) Brugada J, Brugada R, Antzelevitch C, et al. Long-term follow-up of individuals with the electrocardiographic pattern of right bundle-branch block and ST-segment elevation in precordial leads V1 to V3. Circulation 2002; 105: 73-78. – reference: 23) Chinushi M, Washizuka T, Chinushi Y, et al. Induction of ventricular fibrillation in Brugada syndrome by site-specific right ventricular premature depolarization. Pacing Clin Electro-physiol 2002; 25: 1649-1651. – reference: 10) Shimizu W, Antzelevitch C, Suyama K, et al. Effect of sodium channel blockers on ST segment, QRS duration, and corrected QT interval in patients with Brugada syndrome. J Cardiovasc Electrophysiol 2000; 11: 1320-1329. |
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| Snippet | ブルガダ症候群 (BS) における心室細動 (VF) の発生機序として，右室流出路心筋活動電位波形の第 1 相の増強とそれに続く活動電位ドームの減高，消失に基 づく phase 2 reentry が注目されている．我々は BS と対照群に対し右室流出路 (RVOT) で単相性活動電位を記 録し，有効不応期... |
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| StartPage | 293 |
| SubjectTerms | ブルガダ症候群 単相性活動電位 右室流出路 回復特性 |
| Subtitle | 対照群との比較検討 |
| Title | ブルガダ症候群における心室細動易誘発性と右室流出路単相性活動電位持続時間回復特性の関連 |
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