特発性単形性心室頻拍に対するCa拮抗薬の使い方
特発性単形性心室頻拍（VT）における特発性は，通常の検査（身体所見，心電図，胸部レントゲン，心臓超音波検査，血液検査）では不整脈以外に異常を認めないことより診断される．したがって，特発性と診断された症例でも，MRI，心筋生検および遺伝子解析などの方法を用いて詳細に調べると，異常が認められる可能性がある．単形性は，VT時の心電図で診断され，QRS波形が単一で一定の場合である．特発性単形性は主にその発生部位から，(1)左脚束枝起源，(2)心室流出路起源，(3)房室弁輪部起源，(4)その他の部位起源，に分類される．また，薬物の有効性から，左脚束枝起源VTはベラパミル感受性VT，心室流出路起源VTはア...
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| Published in | 心電図 Vol. 30; no. 1; pp. 46 - 54 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本不整脈心電学会
2010
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1660 1884-2437 |
| DOI | 10.5105/jse.30.46 |
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| Abstract | 特発性単形性心室頻拍（VT）における特発性は，通常の検査（身体所見，心電図，胸部レントゲン，心臓超音波検査，血液検査）では不整脈以外に異常を認めないことより診断される．したがって，特発性と診断された症例でも，MRI，心筋生検および遺伝子解析などの方法を用いて詳細に調べると，異常が認められる可能性がある．単形性は，VT時の心電図で診断され，QRS波形が単一で一定の場合である．特発性単形性は主にその発生部位から，(1)左脚束枝起源，(2)心室流出路起源，(3)房室弁輪部起源，(4)その他の部位起源，に分類される．また，薬物の有効性から，左脚束枝起源VTはベラパミル感受性VT，心室流出路起源VTはアデノシン感受性VTと各々よばれている．器質的心疾患に合併するVTの薬物治療にはアミオダロンが選択されることが多いが，特発性と診断された患者にはCa拮抗薬が著効する場合がある．本稿では，特発性単形性VTのうち，頻度が高い左脚束枝起源VT（ベラパミル感受性VT）と心室流出路起源VT（アデノシン感受性VT）を取り上げる． |
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| AbstractList | 特発性単形性心室頻拍（VT）における特発性は，通常の検査（身体所見，心電図，胸部レントゲン，心臓超音波検査，血液検査）では不整脈以外に異常を認めないことより診断される．したがって，特発性と診断された症例でも，MRI，心筋生検および遺伝子解析などの方法を用いて詳細に調べると，異常が認められる可能性がある．単形性は，VT時の心電図で診断され，QRS波形が単一で一定の場合である．特発性単形性は主にその発生部位から，(1)左脚束枝起源，(2)心室流出路起源，(3)房室弁輪部起源，(4)その他の部位起源，に分類される．また，薬物の有効性から，左脚束枝起源VTはベラパミル感受性VT，心室流出路起源VTはアデノシン感受性VTと各々よばれている．器質的心疾患に合併するVTの薬物治療にはアミオダロンが選択されることが多いが，特発性と診断された患者にはCa拮抗薬が著効する場合がある．本稿では，特発性単形性VTのうち，頻度が高い左脚束枝起源VT（ベラパミル感受性VT）と心室流出路起源VT（アデノシン感受性VT）を取り上げる． |
| Author | 大江, 透 |
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| References | 10) Buxton AE, Marchlinski FE, Doherty JU, Cassidy DM, Vassallo JA, Flores BT, Josephson ME : Repetitive, monomorphic ventricular tachycardia : clinical and electrophysiologic characteristics in patients with and patients without organic heart disease. Am J Cardiol, 1984 ; 54 : 997-1002 15) Lerman BB : Mecanism of ouflow tract tachycardia. Heart Rhythm, 2007 ; 4 : 973-976 12) Lerman BB, Belardinelli L, West GA, Berne RM, DiMarco JP : Adenosine-sensitive ventricular tachycardia : evidence suggesting cyclic AMP-mediated triggered activity. Circulation, 1986 ; 74 : 270-280 4) Belhassen B, Rotmensch HH, Laniado S : Response of recurrent sustained ventricular tachycardia to verapamil. Br Heart J, 1981 ; 46 : 679-682 14) Lerman BB, Stien KM, Markowitz SM, Mittal S, Iwai S : Ventricular Tachycardia in Patients with structurally Normal Hearts. Cardiac Electropysiology. From Cell To Bedside. Edi. Zipe / Jalife. Sunders. Edition4. Pp. 668-676 5) Ohe T, Aihara N, Kamakura S, Kurita T, Shimizu W, Shimomura K : Long-term outcome of verapamil-sensitive sustained left ventricular tachycardia in patients without structural heart disease. J Am Coll Cardiol, 1995 ; 25 : 54-58 1) Lin FC, Finley CD, Rahimtoola SH, Wu D : IIdiopathic paroxysmal ventricular tachycardia with a QRS pattern of right bundle branch block and left axis deviation : a unique clinical entity with specific properties. Am J Cardiol, 1983 ; 52 : 95-100 2) Ohe T, Shimomura K, Aihara N, Kamakura S, Matsuhisa M, Sato I, Nakagawa H, Shimizu A : Idiopathic sustained left ventricular tachycardia : clinical and electrophysiologic characteristics. Circulation, 1988 ; 77 : 560-568 9) Tsuchiya T, Okumura K, Honda T, Iwasa A, Ashikaga K : Effects of verapamil and lidocaine on two components of the re-entry circuit of verapamil-senstitive idiopathic left ventricular tachycardia. J Am Coll Cardiol, 2001 ; 37 : 1415-1421 13) Ohe T, Shimomura K, Matsuhisa M, Kamakura S, Shimizu A, Aihara N, Sato I, Nakajima K : The electrophysiological characteristics of various types of paroxysmal tachycardias. Jpn Circ J, 1986 ; 50 : 99-108 7) Suwa M, Yoneda Y, Nagao H, Sakai Y, Nakayama Y, Hirota Y, Kawamura K, Iwa T : Surgical correction of idiopathic paroxysmal ventricular tachycardia possibly related to left ventricular false tendon. Am J Cardiol, 1989 ; 64 : 1217-1220 11) Kamakura S, Shimizu W, Matsuo K, Taguchi A, Suyama K, Kurita T, Aihara N, Ohe T, Shimomura K : Localization of optimal ablation site of idiopathic ventricular tachycardia from right and left ventricular outflow tract by body surface ECG. Circulation, 1998 ; 98 : 1525-1533 16) Ohe T, Kusano K F, Morita H, Emori T, Suyama K, Shimizu W, Aihara N, Kurita T, Kamakura S : Catheter ablation of idiopathic ventricular tachycardia and bundle branch reentrant ventricular trachycardia. Catheter ablation of arrhythmias. Second edition. (Ed by Zipes D P, Haïssaguerre M) Futura Publishing Company, Inc, NY, 2002 ; 345-374 8) Thakur RK, Klein GJ, Sivaram CA, Zardini M, Schleinkofer DE, Nakagawa H, Yee R, Jackman WM : Anatomic substrate for idiopathic left ventricular tachycardia. Circulation, 1996 1 ; 93 : 497-501 6) Nogami A, Naito S, Tada H, Taniguchi K, Okamoto Y, Nishimura S, Yamauchi Y, Aonuma K, Goya M, Iesaka Y, Hiroe M : Demonstration of diastolic and presystolic Purkinje potentials as critical potentials in a macroreentry circuit of verapamil-sensitive idiopathic left ventricular tachycardia. nJ Am Coll Cardiol, 2000 ; 36 : 811-823 3) Ward DE, Nathan AW, Camm AJ : Fascicular tachycardia sensitive to calcium antagonists. Eur Heart J, 1984 ; 5 : 896-905 |
| References_xml | – reference: 3) Ward DE, Nathan AW, Camm AJ : Fascicular tachycardia sensitive to calcium antagonists. Eur Heart J, 1984 ; 5 : 896-905 – reference: 10) Buxton AE, Marchlinski FE, Doherty JU, Cassidy DM, Vassallo JA, Flores BT, Josephson ME : Repetitive, monomorphic ventricular tachycardia : clinical and electrophysiologic characteristics in patients with and patients without organic heart disease. Am J Cardiol, 1984 ; 54 : 997-1002 – reference: 2) Ohe T, Shimomura K, Aihara N, Kamakura S, Matsuhisa M, Sato I, Nakagawa H, Shimizu A : Idiopathic sustained left ventricular tachycardia : clinical and electrophysiologic characteristics. Circulation, 1988 ; 77 : 560-568 – reference: 5) Ohe T, Aihara N, Kamakura S, Kurita T, Shimizu W, Shimomura K : Long-term outcome of verapamil-sensitive sustained left ventricular tachycardia in patients without structural heart disease. J Am Coll Cardiol, 1995 ; 25 : 54-58 – reference: 6) Nogami A, Naito S, Tada H, Taniguchi K, Okamoto Y, Nishimura S, Yamauchi Y, Aonuma K, Goya M, Iesaka Y, Hiroe M : Demonstration of diastolic and presystolic Purkinje potentials as critical potentials in a macroreentry circuit of verapamil-sensitive idiopathic left ventricular tachycardia. nJ Am Coll Cardiol, 2000 ; 36 : 811-823 – reference: 8) Thakur RK, Klein GJ, Sivaram CA, Zardini M, Schleinkofer DE, Nakagawa H, Yee R, Jackman WM : Anatomic substrate for idiopathic left ventricular tachycardia. Circulation, 1996 1 ; 93 : 497-501 – reference: 11) Kamakura S, Shimizu W, Matsuo K, Taguchi A, Suyama K, Kurita T, Aihara N, Ohe T, Shimomura K : Localization of optimal ablation site of idiopathic ventricular tachycardia from right and left ventricular outflow tract by body surface ECG. Circulation, 1998 ; 98 : 1525-1533 – reference: 13) Ohe T, Shimomura K, Matsuhisa M, Kamakura S, Shimizu A, Aihara N, Sato I, Nakajima K : The electrophysiological characteristics of various types of paroxysmal tachycardias. Jpn Circ J, 1986 ; 50 : 99-108 – reference: 16) Ohe T, Kusano K F, Morita H, Emori T, Suyama K, Shimizu W, Aihara N, Kurita T, Kamakura S : Catheter ablation of idiopathic ventricular tachycardia and bundle branch reentrant ventricular trachycardia. Catheter ablation of arrhythmias. Second edition. (Ed by Zipes D P, Haïssaguerre M) Futura Publishing Company, Inc, NY, 2002 ; 345-374 – reference: 4) Belhassen B, Rotmensch HH, Laniado S : Response of recurrent sustained ventricular tachycardia to verapamil. Br Heart J, 1981 ; 46 : 679-682 – reference: 14) Lerman BB, Stien KM, Markowitz SM, Mittal S, Iwai S : Ventricular Tachycardia in Patients with structurally Normal Hearts. Cardiac Electropysiology. From Cell To Bedside. Edi. Zipe / Jalife. Sunders. Edition4. Pp. 668-676 – reference: 1) Lin FC, Finley CD, Rahimtoola SH, Wu D : IIdiopathic paroxysmal ventricular tachycardia with a QRS pattern of right bundle branch block and left axis deviation : a unique clinical entity with specific properties. Am J Cardiol, 1983 ; 52 : 95-100 – reference: 9) Tsuchiya T, Okumura K, Honda T, Iwasa A, Ashikaga K : Effects of verapamil and lidocaine on two components of the re-entry circuit of verapamil-senstitive idiopathic left ventricular tachycardia. J Am Coll Cardiol, 2001 ; 37 : 1415-1421 – reference: 15) Lerman BB : Mecanism of ouflow tract tachycardia. Heart Rhythm, 2007 ; 4 : 973-976 – reference: 12) Lerman BB, Belardinelli L, West GA, Berne RM, DiMarco JP : Adenosine-sensitive ventricular tachycardia : evidence suggesting cyclic AMP-mediated triggered activity. Circulation, 1986 ; 74 : 270-280 – reference: 7) Suwa M, Yoneda Y, Nagao H, Sakai Y, Nakayama Y, Hirota Y, Kawamura K, Iwa T : Surgical correction of idiopathic paroxysmal ventricular tachycardia possibly related to left ventricular false tendon. Am J Cardiol, 1989 ; 64 : 1217-1220 |
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| SubjectTerms | アデノシン感受性心室頻拍 ベラパミル感受性心室頻拍 心室流出路起源特発性心室頻拍 束枝起源心室頻拍 特発性単形性心室頻拍 |
| Title | 特発性単形性心室頻拍に対するCa拮抗薬の使い方 |
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