ベラパミル服用下にバルサルバ手技で停止した右脚ブロック+左軸偏位型心室頻拍の2例
特発性の右脚ブロック+左軸偏位型の持続型心室頻拍2例で, バルサルバ手技により再現性をもって頻拍が停止することを認めたので報告する.症例は40歳と15歳の男性で, 持続型心室頻拍を繰り返していた.心臓カテーテル検査を含む諸検査で, 器質的疾患は認められなかった.電気生理検査にて心室頻拍は繰り返し誘発と停止可能で, 早期刺激の連結期と最後の刺激から頻拍の第1拍目までの間隔は逆相関を示した.プロプラノロールは両例とも無効で, プロカインアミドとベラパミルはともに停止効果を認め, 発作時の頻拍レートも低下させた.ベラパミル投与下の頻拍レートの低下が最も著明で, このときのみバルサルバ手技が頻拍を停止...
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| Published in | 心電図 Vol. 9; no. 4; pp. 464 - 470 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本不整脈心電学会
1989
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1660 1884-2437 |
| DOI | 10.5105/jse.9.464 |
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| Abstract | 特発性の右脚ブロック+左軸偏位型の持続型心室頻拍2例で, バルサルバ手技により再現性をもって頻拍が停止することを認めたので報告する.症例は40歳と15歳の男性で, 持続型心室頻拍を繰り返していた.心臓カテーテル検査を含む諸検査で, 器質的疾患は認められなかった.電気生理検査にて心室頻拍は繰り返し誘発と停止可能で, 早期刺激の連結期と最後の刺激から頻拍の第1拍目までの間隔は逆相関を示した.プロプラノロールは両例とも無効で, プロカインアミドとベラパミルはともに停止効果を認め, 発作時の頻拍レートも低下させた.ベラパミル投与下の頻拍レートの低下が最も著明で, このときのみバルサルバ手技が頻拍を停止させた.ベラパミル反応性の心室頻拍でバルサルバ手技が頻拍停止効果を有したことは興味深いと思われ報告する. |
|---|---|
| AbstractList | 特発性の右脚ブロック+左軸偏位型の持続型心室頻拍2例で, バルサルバ手技により再現性をもって頻拍が停止することを認めたので報告する.症例は40歳と15歳の男性で, 持続型心室頻拍を繰り返していた.心臓カテーテル検査を含む諸検査で, 器質的疾患は認められなかった.電気生理検査にて心室頻拍は繰り返し誘発と停止可能で, 早期刺激の連結期と最後の刺激から頻拍の第1拍目までの間隔は逆相関を示した.プロプラノロールは両例とも無効で, プロカインアミドとベラパミルはともに停止効果を認め, 発作時の頻拍レートも低下させた.ベラパミル投与下の頻拍レートの低下が最も著明で, このときのみバルサルバ手技が頻拍を停止させた.ベラパミル反応性の心室頻拍でバルサルバ手技が頻拍停止効果を有したことは興味深いと思われ報告する. |
| Author | 相沢, 義房 田村, 真 笹川, 康夫 柴田, 昭 松原, 琢 高橋, 正 佐藤, 政仁 江部, 克也 千葉, 泰子 |
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| References | 28) Sakman B, Noma A, Trautwein W : Acetylcholin activation for single muscarinic K channels in isolated pacemaker cells of the mammalian heart. Nature 303 : 250, 1983 13) Sethi KK, Mohan JC, Gupta MP: Verapamil in idiopathic ventricular tachycardia of right bundle branch block : observation during electrophysiologic and exercise testing. PACE 9 : 8, 1986 18) Okumura K, Henthorn RW, Epstein AE, Plumb VJ, Waldo AL: Further observations on transient entrainment : importance of pacing site and properties of the components of the reentry circuit. Circulation 72 : 1293, 1985 22) Kent KM, Epstein SE, Cooper T, Jacobowitz DM : Cholinergic innervation of the canine and human ventricular conduction system. Circulation 50 : 948, 1974 8) Waxman MB, Wald RW : Termination of ventricular tachycardia by an increase in cardiac vagal drive. Circulation 56 : 385, 1977 7) Waxman MB, Downar E, Berman ND, Felderhof CH : Phenylephrine (Neosynephrine) terminated ventricular tachycardia. Circulation 50 : 656, 1974 3) Sung RJ, Schen EN, Morady F, Scheinman MM, Hess D, Botvinick EH: Electrophysiologic mechanism of exercise-induced sustained ventricular tachycardia. Am J Cardiol 51: 525, 1983 6) 林雅美, 森川政嗣, 村田実, 渋谷敏幸, 矢沢良光, 相沢義房, 小沢武文, 柴田昭: 心室性期外収縮に迷走神経刺激が有効であった1例. 心電図 4: 700, 1984 23) Rosen MR, Hoffman BF : The vagus and ventricle. Cir Res 42 : 12, 1978 5) Weiss T, Lattin GM, Engelman K : Vagally mediated suppression of premature ventricular contractions in man. Am Heart J 89 : 700, 1975 29) Cranfield PF : Action potentials, after -potentials, and arrhythmias. Cir Res 41: 415, 1977 2) Freedman RA, Swerdlow CD, Echt DS, Winkle RA, Soderholm - Difatte V, Mason JW : Facilitation of ventricular tachyarrhythmia induction by isoproterenolol. Am J Cardiol 54 : 765, 1984 11) German LD, Packer DL, Bardy GH, Gallagher JJ : Ventricular tachycardia induced by atrial stimulation in patients without symptomatic cardiac disease. Am J Cardiol 52 : 1202, 1983 20) Aizawa Y, Oda H, Satoh M, Shibata A, Miyamura H, Eguchi S : Transient entrainment of sustained ventricular tachycardia with continuous local electrical activity. Am Heart J 114 : 182, 1987 16) Josephson ME, Horowitz LN, Farshidi A, Kastor JA : Recurrent sustained ventricular tachycardia. I. Mechanism. Circulation 57 : 43, 1978 26) Kameyama M, Hofmann F, Trautwein W : On the mechanism of β-adrenergic regulation of the Ca channel in the guineapig heart. Pfluegers Arch 405 : 285, 1985 14) Kasanuki H, Ohnishi S, Tanaka E, Hirosawa K : Idiopathic sustained ventricular tachycardia responsive to verapamil: clinical electrocardiographic and electrophysiologic considerations. Jpn Cir J 50 : 109, 1986 15) Wellens HJJ : Values and limitations of programmed electrical stimulation of the heart in the study and treatment of tachycardias. Circulation 57 : 845, 1978 12) Belhassen B, Shapiro I, Pelleg A, Copperman I, Kauli N, Laniado S : Idiopathic recurrent sustained ventricular tachycardia responsive to verapamil. Am Heart J 108 : 1034, 1984 17) Aizawa Y, Satoh M, Suzuki K, Aizawa M, Funazaki T, Ebe K, Niwano S, Sibata A, Josephson ME : Early experiences of endocardial catheter mapping of the left ventricle. Jpn Cir J 51: 1283, 1987 9) Waxman MB, Staniloff H, Wald RW : Respiratory and vagal modulation of ventricular tachycardia. J Electrocardiol 14 : 83, 1981 1) Lown B, DeSilva RA : Roles of psychologic stress and autonomic nervous system changes in provocation of ventricular premature complexes. Am J Cardiol 41: 979, 1978 19) Lin H, Mann DE, Luck JC, Kraftchek J, Magro S, Wyndham CRC : Two different patterns of entrainment of ventricular tachycardia. J Electrocardiol 20: 55, 1987 25) Matsuda H, Noma A : Isolation of calcium current and its sensitivity to monovalent cations in dialysed ventricular cells of guineapig. J Physiol (Lond) 357 : 553, 1984 21) Josephson ME, Wit AL: Fractinated electrical activity and continuous electrical activity : fact or artifact? Circulation 70 : 529, 1984 4) Scherf D, Blumenfeld S, Vildiz M : Experimental study on ventricular extrasystoles provoked by vagal stimulations. Am Heart J 62 : 670, 1961 27) Hescheler J, Kameyama M, Trautwein W : On the mechanism of muscarinic inhibition of the cardiac Ca current. Pfluegers Arch 407 : 182, 1986 24) Biegon R, Pappano A : Dual mechanism for inhibition of calcium - dependent action potential in avian ventricular muscle. Cir Res 46 : 353, 1980 10) Lin FC, Finley CD, Rahimitoola SH, Wu D : Idiopathic paroxysmal ventricular tachycardia with QRS pattern of right bundle branch block and left axis deviation. Am J Cardiol 52 : 95, 1983 30) Brugada P, Wellens HJJ : The role of triggered activity in clinical ventricular arrhythmias. PACE 7 : 260, 1984 |
| References_xml | – reference: 19) Lin H, Mann DE, Luck JC, Kraftchek J, Magro S, Wyndham CRC : Two different patterns of entrainment of ventricular tachycardia. J Electrocardiol 20: 55, 1987 – reference: 6) 林雅美, 森川政嗣, 村田実, 渋谷敏幸, 矢沢良光, 相沢義房, 小沢武文, 柴田昭: 心室性期外収縮に迷走神経刺激が有効であった1例. 心電図 4: 700, 1984 – reference: 26) Kameyama M, Hofmann F, Trautwein W : On the mechanism of β-adrenergic regulation of the Ca channel in the guineapig heart. Pfluegers Arch 405 : 285, 1985 – reference: 23) Rosen MR, Hoffman BF : The vagus and ventricle. Cir Res 42 : 12, 1978 – reference: 3) Sung RJ, Schen EN, Morady F, Scheinman MM, Hess D, Botvinick EH: Electrophysiologic mechanism of exercise-induced sustained ventricular tachycardia. Am J Cardiol 51: 525, 1983 – reference: 2) Freedman RA, Swerdlow CD, Echt DS, Winkle RA, Soderholm - Difatte V, Mason JW : Facilitation of ventricular tachyarrhythmia induction by isoproterenolol. Am J Cardiol 54 : 765, 1984 – reference: 28) Sakman B, Noma A, Trautwein W : Acetylcholin activation for single muscarinic K channels in isolated pacemaker cells of the mammalian heart. Nature 303 : 250, 1983 – reference: 17) Aizawa Y, Satoh M, Suzuki K, Aizawa M, Funazaki T, Ebe K, Niwano S, Sibata A, Josephson ME : Early experiences of endocardial catheter mapping of the left ventricle. Jpn Cir J 51: 1283, 1987 – reference: 22) Kent KM, Epstein SE, Cooper T, Jacobowitz DM : Cholinergic innervation of the canine and human ventricular conduction system. Circulation 50 : 948, 1974 – reference: 15) Wellens HJJ : Values and limitations of programmed electrical stimulation of the heart in the study and treatment of tachycardias. Circulation 57 : 845, 1978 – reference: 1) Lown B, DeSilva RA : Roles of psychologic stress and autonomic nervous system changes in provocation of ventricular premature complexes. Am J Cardiol 41: 979, 1978 – reference: 25) Matsuda H, Noma A : Isolation of calcium current and its sensitivity to monovalent cations in dialysed ventricular cells of guineapig. J Physiol (Lond) 357 : 553, 1984 – reference: 8) Waxman MB, Wald RW : Termination of ventricular tachycardia by an increase in cardiac vagal drive. Circulation 56 : 385, 1977 – reference: 5) Weiss T, Lattin GM, Engelman K : Vagally mediated suppression of premature ventricular contractions in man. Am Heart J 89 : 700, 1975 – reference: 29) Cranfield PF : Action potentials, after -potentials, and arrhythmias. Cir Res 41: 415, 1977 – reference: 14) Kasanuki H, Ohnishi S, Tanaka E, Hirosawa K : Idiopathic sustained ventricular tachycardia responsive to verapamil: clinical electrocardiographic and electrophysiologic considerations. Jpn Cir J 50 : 109, 1986 – reference: 11) German LD, Packer DL, Bardy GH, Gallagher JJ : Ventricular tachycardia induced by atrial stimulation in patients without symptomatic cardiac disease. Am J Cardiol 52 : 1202, 1983 – reference: 16) Josephson ME, Horowitz LN, Farshidi A, Kastor JA : Recurrent sustained ventricular tachycardia. I. Mechanism. Circulation 57 : 43, 1978 – reference: 27) Hescheler J, Kameyama M, Trautwein W : On the mechanism of muscarinic inhibition of the cardiac Ca current. Pfluegers Arch 407 : 182, 1986 – reference: 7) Waxman MB, Downar E, Berman ND, Felderhof CH : Phenylephrine (Neosynephrine) terminated ventricular tachycardia. Circulation 50 : 656, 1974 – reference: 10) Lin FC, Finley CD, Rahimitoola SH, Wu D : Idiopathic paroxysmal ventricular tachycardia with QRS pattern of right bundle branch block and left axis deviation. Am J Cardiol 52 : 95, 1983 – reference: 9) Waxman MB, Staniloff H, Wald RW : Respiratory and vagal modulation of ventricular tachycardia. J Electrocardiol 14 : 83, 1981 – reference: 24) Biegon R, Pappano A : Dual mechanism for inhibition of calcium - dependent action potential in avian ventricular muscle. Cir Res 46 : 353, 1980 – reference: 4) Scherf D, Blumenfeld S, Vildiz M : Experimental study on ventricular extrasystoles provoked by vagal stimulations. Am Heart J 62 : 670, 1961 – reference: 20) Aizawa Y, Oda H, Satoh M, Shibata A, Miyamura H, Eguchi S : Transient entrainment of sustained ventricular tachycardia with continuous local electrical activity. Am Heart J 114 : 182, 1987 – reference: 30) Brugada P, Wellens HJJ : The role of triggered activity in clinical ventricular arrhythmias. PACE 7 : 260, 1984 – reference: 12) Belhassen B, Shapiro I, Pelleg A, Copperman I, Kauli N, Laniado S : Idiopathic recurrent sustained ventricular tachycardia responsive to verapamil. Am Heart J 108 : 1034, 1984 – reference: 18) Okumura K, Henthorn RW, Epstein AE, Plumb VJ, Waldo AL: Further observations on transient entrainment : importance of pacing site and properties of the components of the reentry circuit. Circulation 72 : 1293, 1985 – reference: 13) Sethi KK, Mohan JC, Gupta MP: Verapamil in idiopathic ventricular tachycardia of right bundle branch block : observation during electrophysiologic and exercise testing. PACE 9 : 8, 1986 – reference: 21) Josephson ME, Wit AL: Fractinated electrical activity and continuous electrical activity : fact or artifact? Circulation 70 : 529, 1984 |
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| Snippet | 特発性の右脚ブロック+左軸偏位型の持続型心室頻拍2例で, バルサルバ手技により再現性をもって頻拍が停止することを認めたので報告する.症例は40歳と15歳の男性で, 持続型心室頻拍を繰り返していた.心臓カテーテル検査を含む諸検査で, 器質的疾患は認められなかった.電気生理検査にて心室頻拍は繰り返し誘発と停止可能で,... |
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| StartPage | 464 |
| SubjectTerms | バルサルバ手技 ベラパミル 心室頻拍 電気生理検査 |
| Title | ベラパミル服用下にバルサルバ手技で停止した右脚ブロック+左軸偏位型心室頻拍の2例 |
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