Flecainideとβ遮断薬の併用が有効であったFallot四徴症根治術後の持続性心室頻拍の1例
症例は31歳女性.5歳時Fallot四徴症根治術を, 28歳時遺残VSDのpatch閉鎖術および右室流出路のpatch拡大術を受けた.術後心電図は心房粗動 (AF) , 完全右脚ブロックであった.以後, digoxinが投与されていたが, 時々動悸, 息切れが出現していた.平成元年10月16日長い動悸発作の後失神し心室頻拍 (VT) 状態で入院した.VTはlidocaine, procainamide, disopyramide, verapamil投与で停止せず, 右室心尖部刺激で停止した.電気生理学的検査時, 右室期外刺激で左脚ブロック型のVTが誘発された.Cibenzoline投与後AF...
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| Published in | 心電図 Vol. 11; no. 6; pp. 772 - 778 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本不整脈心電学会
30.11.1991
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1660 1884-2437 |
| DOI | 10.5105/jse.11.772 |
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| Abstract | 症例は31歳女性.5歳時Fallot四徴症根治術を, 28歳時遺残VSDのpatch閉鎖術および右室流出路のpatch拡大術を受けた.術後心電図は心房粗動 (AF) , 完全右脚ブロックであった.以後, digoxinが投与されていたが, 時々動悸, 息切れが出現していた.平成元年10月16日長い動悸発作の後失神し心室頻拍 (VT) 状態で入院した.VTはlidocaine, procainamide, disopyramide, verapamil投与で停止せず, 右室心尖部刺激で停止した.電気生理学的検査時, 右室期外刺激で左脚ブロック型のVTが誘発された.Cibenzoline投与後AFによるVTのentrainment現象を認めた.VT誘発予防効果はcibenzoline, mexiletine, disopyramideにはなかったが, flecainide (200mg p.o.) で認めた.Flecainide投与中, シャワーを浴びているときにVTの出現を認めたため, β遮断薬を併用したところ以後1年間VTの再発はない. |
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| AbstractList | 症例は31歳女性.5歳時Fallot四徴症根治術を, 28歳時遺残VSDのpatch閉鎖術および右室流出路のpatch拡大術を受けた.術後心電図は心房粗動 (AF) , 完全右脚ブロックであった.以後, digoxinが投与されていたが, 時々動悸, 息切れが出現していた.平成元年10月16日長い動悸発作の後失神し心室頻拍 (VT) 状態で入院した.VTはlidocaine, procainamide, disopyramide, verapamil投与で停止せず, 右室心尖部刺激で停止した.電気生理学的検査時, 右室期外刺激で左脚ブロック型のVTが誘発された.Cibenzoline投与後AFによるVTのentrainment現象を認めた.VT誘発予防効果はcibenzoline, mexiletine, disopyramideにはなかったが, flecainide (200mg p.o.) で認めた.Flecainide投与中, シャワーを浴びているときにVTの出現を認めたため, β遮断薬を併用したところ以後1年間VTの再発はない. |
| Author | 井上, 博 野崎, 彰 杉本, 恒明 郭, 宗徳 岡部, 英男 碓井, 雅博 山下, 武志 |
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| References | 21) Anastasiou-Napa MI, Anderson JL, Stewart JR, Crevey BJ, Yanowitz FG, Lutz JR, Johnson TA : Occurrence of exercise-induced and spontaneous wide complex tachycardia during therapy with flecainide for complex ventricular arrhythmias : a probable proarrhythmic effect. Am Heart J 113 : 1071, 1987 13) 宮沢総介, 鈴木茂, 新井達太, 田村徹太郎, 石永隆成, 小松親義, 岡村哲失, 西沢直: Fallot四徴症根治術後遠隔期における反復性持続性心室頻拍の一例. 心臓 21: 1424, 1980 2) Chander JS, Wollf GS, Garson A, Bell TJ, Beder SD, Bink-Boelkens M, Byrum CJ, Campbell RM, Deal BJ, Dick II M, Flinn CJ, Gaum WE, Gillette PC, Hordof AJ, Kugler JD, Porter CJ, Walsh EP : Ventricular arrhythmias in post-operative tetralogy of Fallot. Am J Cardiol 65: 655, 1990 9) Kremers MS, Wells PJ, Black WH, Solodyna MA : Entrainment of ventricular tachycardia in postoperative tetralogy of Fallot. Pace 11: 1310, 1988 3) 小田弘隆, 相沢義房, 鈴木薫, 佐藤政仁, 相沢雅美, 村田実, 森川政嗣, 柴田昭, 金沢宏, 宮村治男, 江口昭治: Catheter electrical ablation (カテーテル電気的切除術) が奏功したFallot四徴症根治術後の心室性頻拍症の1例. 心臓 18: 1387, 1986 15) Harken AH, Horowitz LN, Josephson ME : Surgical correction of recurrent sustained ventricular tachycardia following complete repair of tetralogy of Fallot. J Thorac Cardiovasc Surg 80 : 779, 1980 4) Furuse A, Wake K, Kotsuka Y, Asano K : Conduction disturbance and tachyarrhythmia in postoperative ventricular septal defect and tetralogy of Fallot. Jpn Circ J 50: 850, 1986 7) Dunnigan A, Pritzker MR, Benditt DG, Benson DW : Life threatening ventricular tachycardias in late survivors of surgically corrected tetralogy of Fallot. Br Heart J 52: 198, 1984 8) Garson A, Porter CJ, Gillette PC, McNamara DG : Induction of ventricular tachycardia during electrophysiologic study after repair of tetralogy of Fallot. J Am Coll Cardiol 1 (6) : 1493, 1983 23) Lewis GP, Holtzman JL : Interaction of flecainide with digoxin and propranolol. Am J Cardiol 53 : 52 B, 1984 10) Horowitz LN, Vetter VL, Harken AH, Josephson ME : Electrophysiologic characteristics of sustained ventricular tachycardia occurring after repair of tetralogy of Fallot. Am J Cardiol 46: 446, 1980 12) Deal BJ, Scaliotti D, Miller SM, Gallastegui JL, Hariman RJ, Levitsky S : Electrophysiologic drug testing in symptomatic ventricular arrhythmias after repair of tetralogy of Fallot. Am J Cardiol 59 : 1380, 1987 20) Ranger S, Talajic M, Lemery R, Roy D, Nattel S : Amplification of f lecainide - induced ventricular conduction slowing by exercise. A potentially significant clinical consequence of use-dependent sodium channel blockade. Circulation 79 : 1000, 1989 6) Miyamura H, Kanazawa H, Fukuda J, Eguchi S, Morikawa M, Aizawa Y, Matsukawa T : Long-term postoperative status of tetralogy of Fallot. Jpn Circ J 50: 855, 1986 11) Kugler JD, Pinsky WW, Cheatham JP, Hofschire PJ, Mooring PK, Fleming WH : Sustained ventricular tachycardia after repair of tetralogy of Fallot : New electrophysiologic findings. Am J Cardiol 51: 1137, 1983 17) Levi S : Combination therapy for cardiac arrhythmias. Am J Cardiol 61: 95 A, 1988 16) Ross DL, Sze DY, Keefe DL, Swerdlow CD, Echt DS, Griffin JC, Winkle RA, Mason JW Antiarrhythmic drug combinations in the treatment of ventricular tachycardia. Circulation 66 : 1205, 1982 5) Kavey RW, Blackman MS, Sondheimer HM: Incidence and severity of chronic ventricular dysrhythmias after repair of tetralogy of Fallot. Am Heart J 103: 342, 1982 19) 新博次, 井上博, 大城雅也, 平尾見三, 早川弘一, 比江嶋一昌, 杉本恒明: 不整脈治療薬としてのCarteololの位置づけに関する共同研究. 臨床と研究 67: 277, 1990 1) Quattelebaum TG, Varghese PJ, Neill CA, Danahoo JS : Sudden death among postoperative patients with tetralogy of Fallot. A follow-up study of 243 patients for an average of twelve years. Circulation 54: 289, 1976 14) Garson A, Randall DC, Gillette PC, Smith RT, Moak JP, McVey P, McNamara DG : Prevention of sudden death after repair of tetralogy of Fallot : treatment of ventricular arrhythmias. J Am Coil Cardiol 6 : 221, 1985 18) Hirsowitz G, Podrid PJ, Lampert S, Stein J, Lown B : The role of beta blocking agents as adjunct therapy to membrane stabilizing drugs in malignant ventricular arrhythmia. Am Heart J 111: 852, 1986 22) Myerberg RJ, Kessler KM, Cox MM, Huikuri H, Terracall E, Interian Jr. A, Fernandes P, Castellanos A : Reversal of proarrhythmic effects of flecainide acetate and encainide hydrochloride by propranolol. Circulation 80 1571, 1989 |
| References_xml | – reference: 22) Myerberg RJ, Kessler KM, Cox MM, Huikuri H, Terracall E, Interian Jr. A, Fernandes P, Castellanos A : Reversal of proarrhythmic effects of flecainide acetate and encainide hydrochloride by propranolol. Circulation 80 1571, 1989 – reference: 2) Chander JS, Wollf GS, Garson A, Bell TJ, Beder SD, Bink-Boelkens M, Byrum CJ, Campbell RM, Deal BJ, Dick II M, Flinn CJ, Gaum WE, Gillette PC, Hordof AJ, Kugler JD, Porter CJ, Walsh EP : Ventricular arrhythmias in post-operative tetralogy of Fallot. Am J Cardiol 65: 655, 1990 – reference: 4) Furuse A, Wake K, Kotsuka Y, Asano K : Conduction disturbance and tachyarrhythmia in postoperative ventricular septal defect and tetralogy of Fallot. Jpn Circ J 50: 850, 1986 – reference: 6) Miyamura H, Kanazawa H, Fukuda J, Eguchi S, Morikawa M, Aizawa Y, Matsukawa T : Long-term postoperative status of tetralogy of Fallot. Jpn Circ J 50: 855, 1986 – reference: 10) Horowitz LN, Vetter VL, Harken AH, Josephson ME : Electrophysiologic characteristics of sustained ventricular tachycardia occurring after repair of tetralogy of Fallot. Am J Cardiol 46: 446, 1980 – reference: 20) Ranger S, Talajic M, Lemery R, Roy D, Nattel S : Amplification of f lecainide - induced ventricular conduction slowing by exercise. A potentially significant clinical consequence of use-dependent sodium channel blockade. Circulation 79 : 1000, 1989 – reference: 12) Deal BJ, Scaliotti D, Miller SM, Gallastegui JL, Hariman RJ, Levitsky S : Electrophysiologic drug testing in symptomatic ventricular arrhythmias after repair of tetralogy of Fallot. Am J Cardiol 59 : 1380, 1987 – reference: 14) Garson A, Randall DC, Gillette PC, Smith RT, Moak JP, McVey P, McNamara DG : Prevention of sudden death after repair of tetralogy of Fallot : treatment of ventricular arrhythmias. J Am Coil Cardiol 6 : 221, 1985 – reference: 8) Garson A, Porter CJ, Gillette PC, McNamara DG : Induction of ventricular tachycardia during electrophysiologic study after repair of tetralogy of Fallot. J Am Coll Cardiol 1 (6) : 1493, 1983 – reference: 16) Ross DL, Sze DY, Keefe DL, Swerdlow CD, Echt DS, Griffin JC, Winkle RA, Mason JW Antiarrhythmic drug combinations in the treatment of ventricular tachycardia. Circulation 66 : 1205, 1982 – reference: 17) Levi S : Combination therapy for cardiac arrhythmias. Am J Cardiol 61: 95 A, 1988 – reference: 7) Dunnigan A, Pritzker MR, Benditt DG, Benson DW : Life threatening ventricular tachycardias in late survivors of surgically corrected tetralogy of Fallot. Br Heart J 52: 198, 1984 – reference: 5) Kavey RW, Blackman MS, Sondheimer HM: Incidence and severity of chronic ventricular dysrhythmias after repair of tetralogy of Fallot. Am Heart J 103: 342, 1982 – reference: 13) 宮沢総介, 鈴木茂, 新井達太, 田村徹太郎, 石永隆成, 小松親義, 岡村哲失, 西沢直: Fallot四徴症根治術後遠隔期における反復性持続性心室頻拍の一例. 心臓 21: 1424, 1980 – reference: 15) Harken AH, Horowitz LN, Josephson ME : Surgical correction of recurrent sustained ventricular tachycardia following complete repair of tetralogy of Fallot. J Thorac Cardiovasc Surg 80 : 779, 1980 – reference: 19) 新博次, 井上博, 大城雅也, 平尾見三, 早川弘一, 比江嶋一昌, 杉本恒明: 不整脈治療薬としてのCarteololの位置づけに関する共同研究. 臨床と研究 67: 277, 1990 – reference: 9) Kremers MS, Wells PJ, Black WH, Solodyna MA : Entrainment of ventricular tachycardia in postoperative tetralogy of Fallot. Pace 11: 1310, 1988 – reference: 21) Anastasiou-Napa MI, Anderson JL, Stewart JR, Crevey BJ, Yanowitz FG, Lutz JR, Johnson TA : Occurrence of exercise-induced and spontaneous wide complex tachycardia during therapy with flecainide for complex ventricular arrhythmias : a probable proarrhythmic effect. Am Heart J 113 : 1071, 1987 – reference: 1) Quattelebaum TG, Varghese PJ, Neill CA, Danahoo JS : Sudden death among postoperative patients with tetralogy of Fallot. A follow-up study of 243 patients for an average of twelve years. Circulation 54: 289, 1976 – reference: 23) Lewis GP, Holtzman JL : Interaction of flecainide with digoxin and propranolol. Am J Cardiol 53 : 52 B, 1984 – reference: 3) 小田弘隆, 相沢義房, 鈴木薫, 佐藤政仁, 相沢雅美, 村田実, 森川政嗣, 柴田昭, 金沢宏, 宮村治男, 江口昭治: Catheter electrical ablation (カテーテル電気的切除術) が奏功したFallot四徴症根治術後の心室性頻拍症の1例. 心臓 18: 1387, 1986 – reference: 18) Hirsowitz G, Podrid PJ, Lampert S, Stein J, Lown B : The role of beta blocking agents as adjunct therapy to membrane stabilizing drugs in malignant ventricular arrhythmia. Am Heart J 111: 852, 1986 – reference: 11) Kugler JD, Pinsky WW, Cheatham JP, Hofschire PJ, Mooring PK, Fleming WH : Sustained ventricular tachycardia after repair of tetralogy of Fallot : New electrophysiologic findings. Am J Cardiol 51: 1137, 1983 |
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| Snippet | 症例は31歳女性.5歳時Fallot四徴症根治術を, 28歳時遺残VSDのpatch閉鎖術および右室流出路のpatch拡大術を受けた.術後心電図は心房粗動 (AF) , 完全右脚ブロックであった.以後, digoxinが投与されていたが, 時々動悸,... |
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| SubjectTerms | Fallot四徴症術後 β遮断薬 持続性心室頻拍 |
| Title | Flecainideとβ遮断薬の併用が有効であったFallot四徴症根治術後の持続性心室頻拍の1例 |
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