A case of junctional tachycardia cured by radiofrequency catheter ablation at the site of slow pathway area that was difficult to distinguish from common atrioventricular nodal reentrant tachycardia
症例は46歳, 女性の発作性上室性頻拍(paroxysmal supraventricular tachycardia; PSVT) 症例. PSVTは心拍数107bpmで, QRSの終末部にP波を認めた. 心臓電気生理学的検査ではコントロールにて室房伝導は認めず, 頻拍は誘発不能. イソプロテレノール(isoproterenol; ISP)負荷にて房室結節での室房伝導が出現, 2連の心房早期刺激法(S1S2S3法)のみにて周期480msecのclinical PSVTが誘発された. 頻拍時に加えた心室単一刺激ではpreexitation phenomenonは認めず, 心房からのentrai...
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| Published in | Shinzo Vol. 42; no. SUPPL.4; pp. S4_50 - S4_60 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japan Heart Foundation
2010
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.42.S4_50 |
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| Abstract | 症例は46歳, 女性の発作性上室性頻拍(paroxysmal supraventricular tachycardia; PSVT) 症例. PSVTは心拍数107bpmで, QRSの終末部にP波を認めた. 心臓電気生理学的検査ではコントロールにて室房伝導は認めず, 頻拍は誘発不能. イソプロテレノール(isoproterenol; ISP)負荷にて房室結節での室房伝導が出現, 2連の心房早期刺激法(S1S2S3法)のみにて周期480msecのclinical PSVTが誘発された. 頻拍時に加えた心室単一刺激ではpreexitation phenomenonは認めず, 心房からのentrainment pacingではslow pathwayではなくfast pathwayがentrainされ, 最終刺激にて心室2重応答(double ventricular response; DVR)様の反応を示して頻拍は持続した. 洞調律時では心房－心室同時早期刺激法など, いかなる刺激にても心室2重応答は認められず房室接合部性頻拍(atrio-ventricular junctional tachycardia; AVJT)と考えたが, 通常型房室結節リエントリー性頻拍(common atrio-ventricular nodal reentrant tachycardia; common AVNRT)との鑑別も困難であったことから, 本例に対してまずslow pathway領域で通電したところ, 心房興奮順序が先のPSVTと同一で周期600msecの, 自然に洞調律に移行する, いわゆる接合部調律が誘発されるのみとなったため終了した. 以後頻拍発作は認めなくなった. 以上, 通常型房室結節リエントリー性頻拍との鑑別に難渋しslow pathway領域からの通電が有効であった, いわゆる房室接合部性頻拍の1例を報告する. |
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| AbstractList | 症例は46歳, 女性の発作性上室性頻拍(paroxysmal supraventricular tachycardia; PSVT) 症例. PSVTは心拍数107bpmで, QRSの終末部にP波を認めた. 心臓電気生理学的検査ではコントロールにて室房伝導は認めず, 頻拍は誘発不能. イソプロテレノール(isoproterenol; ISP)負荷にて房室結節での室房伝導が出現, 2連の心房早期刺激法(S1S2S3法)のみにて周期480msecのclinical PSVTが誘発された. 頻拍時に加えた心室単一刺激ではpreexitation phenomenonは認めず, 心房からのentrainment pacingではslow pathwayではなくfast pathwayがentrainされ, 最終刺激にて心室2重応答(double ventricular response; DVR)様の反応を示して頻拍は持続した. 洞調律時では心房－心室同時早期刺激法など, いかなる刺激にても心室2重応答は認められず房室接合部性頻拍(atrio-ventricular junctional tachycardia; AVJT)と考えたが, 通常型房室結節リエントリー性頻拍(common atrio-ventricular nodal reentrant tachycardia; common AVNRT)との鑑別も困難であったことから, 本例に対してまずslow pathway領域で通電したところ, 心房興奮順序が先のPSVTと同一で周期600msecの, 自然に洞調律に移行する, いわゆる接合部調律が誘発されるのみとなったため終了した. 以後頻拍発作は認めなくなった. 以上, 通常型房室結節リエントリー性頻拍との鑑別に難渋しslow pathway領域からの通電が有効であった, いわゆる房室接合部性頻拍の1例を報告する. |
| Author | Matsumura, Kuniyoshi Asakawa, Tetsuya Sakurabayashi, Tai Nakagawa, Kazuya Yamauchi, Yasuteru Aonuma, Kazutaka |
| Author_FL | 浅川 哲也 山内 康照 青沼 和隆 中川 和也 松村 国佳 桜林 耐 |
| Author_FL_xml | – sequence: 1 fullname: 中川 和也 – sequence: 2 fullname: 浅川 哲也 – sequence: 3 fullname: 松村 国佳 – sequence: 4 fullname: 桜林 耐 – sequence: 5 fullname: 山内 康照 – sequence: 6 fullname: 青沼 和隆 |
| Author_xml | – sequence: 1 fullname: Nakagawa, Kazuya organization: Department of Cardiology, Yamanashi Kousei Hospital – sequence: 1 fullname: Matsumura, Kuniyoshi organization: Department of Cardiology, Yamanashi Kousei Hospital – sequence: 1 fullname: Aonuma, Kazutaka organization: Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba Graduate School of Comprehensive Human Sciences – sequence: 1 fullname: Asakawa, Tetsuya organization: Department of Cardiology, Yamanashi Kousei Hospital – sequence: 1 fullname: Yamauchi, Yasuteru organization: Cardiovasucular Division, Musashino Red Cross Hospital – sequence: 1 fullname: Sakurabayashi, Tai organization: Department of Cardiology, Yamanashi Kousei Hospital |
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| DocumentTitle_FL | 通常型房室結節リエントリー性頻拍との鑑別に難渋し, slow pathway領域からの通電が有効であった, いわゆる房室接合部性頻拍の1例 |
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| References | 3) KOMANDOOR SRIVATHSAN, APOOR S. GAMI, RENEE BARRETT, et al: Differentiating atrioventricular nodal reentrant tachycardia from junctional tachycardia: novel application of the delta H-A interval. J Cardiovasc Electrophysiol 2008; 19: 1-6 8) Sugiyama A, Satoh Y, Ishida Y, et al: Pharmacological and electrophysiological characterization of junctional rhythm during radiofrequency catheter ablation of atrioventricular node: possible involvement of neurotransmitters from autonomic nervous system. Circ J 2002; 66: 696-701 4) 浅川哲也, 望月 淳, 松村国佳, ほか: Slow Pathway領域に対するカテーテルアブレーションが有効であった房室接合部性頻拍の1例. 臨床心臓電気生理 2005; 28: 149-158 10) Yu JC, Lauer MR, Young C, et al: Localization of the origin of the atrioventricular junctional rhythm induced during selective ablation of slow-pathway conduction in patients with atrioventricular node reentrant tachycardia. Am Heart J 1996; 131: 937-946 11) Chen MC, Guo GB: Junctional tachycardia during radiofrequency ablation of the slow pathway in patients with AV nodal reentrant tachycardia: effects of autonomic blockade. J Cardiovasc Electrophysiol 1999; 10: 56-60 6) Ehlert FA, Goldberger JJ, Deal BJ, et al: Successful radiofrequency energy ablation of automatic junctional tachycardia preserving normal atrioventricular nodal conduction. Pacing Clin Electrophysiol 1933; 16: 54-61 9) Thibault B, de Bakker JM, Hocini M, et al: Origin of heat-induced accelerated junctional rhythm. J Cardiovasc Electrophysiol 1998; 9: 631-641 1) Mohamed Hamdan, George F. Van Hare, Westby Fisher, et al: Selective catheter ablation of the tachycardia focus in patients with nonreentrant junctional tachycardia. Am J Cardiol 1996; 7: 1292-1297 5) 関田 学, 林 英守, 小松かおる, ほか: 頻拍の機序として, Slow Pathway領域の異常自動能が推定された房室接合部性頻拍の1例. 臨床心臓電気生理 2009; 32: 115-122 7) Z. Iakobishvili, J. Kusniec, R. Shohat-Zabarsky, et al: Junctional rhythm quantity and duration slow pathway radiofrequency ablation in patients with atrioventricular nodal re-entry supraventricular tachycardia. Europace 2006; 8: 588-591 2) Benzy J. Padanilam, Joseph A. Manfredi, Leonard A. Steinberg, et al: Differentiating junctional tachycardia and atrioventricular node re-entry tachycardia based on response to atrial extrastimulus pacing. J Am Coll Cardiol 2008; 52: 1711-1717 |
| References_xml | – reference: 2) Benzy J. Padanilam, Joseph A. Manfredi, Leonard A. Steinberg, et al: Differentiating junctional tachycardia and atrioventricular node re-entry tachycardia based on response to atrial extrastimulus pacing. J Am Coll Cardiol 2008; 52: 1711-1717 – reference: 3) KOMANDOOR SRIVATHSAN, APOOR S. GAMI, RENEE BARRETT, et al: Differentiating atrioventricular nodal reentrant tachycardia from junctional tachycardia: novel application of the delta H-A interval. J Cardiovasc Electrophysiol 2008; 19: 1-6 – reference: 4) 浅川哲也, 望月 淳, 松村国佳, ほか: Slow Pathway領域に対するカテーテルアブレーションが有効であった房室接合部性頻拍の1例. 臨床心臓電気生理 2005; 28: 149-158 – reference: 8) Sugiyama A, Satoh Y, Ishida Y, et al: Pharmacological and electrophysiological characterization of junctional rhythm during radiofrequency catheter ablation of atrioventricular node: possible involvement of neurotransmitters from autonomic nervous system. Circ J 2002; 66: 696-701 – reference: 7) Z. Iakobishvili, J. Kusniec, R. Shohat-Zabarsky, et al: Junctional rhythm quantity and duration slow pathway radiofrequency ablation in patients with atrioventricular nodal re-entry supraventricular tachycardia. Europace 2006; 8: 588-591 – reference: 5) 関田 学, 林 英守, 小松かおる, ほか: 頻拍の機序として, Slow Pathway領域の異常自動能が推定された房室接合部性頻拍の1例. 臨床心臓電気生理 2009; 32: 115-122 – reference: 9) Thibault B, de Bakker JM, Hocini M, et al: Origin of heat-induced accelerated junctional rhythm. J Cardiovasc Electrophysiol 1998; 9: 631-641 – reference: 1) Mohamed Hamdan, George F. Van Hare, Westby Fisher, et al: Selective catheter ablation of the tachycardia focus in patients with nonreentrant junctional tachycardia. Am J Cardiol 1996; 7: 1292-1297 – reference: 11) Chen MC, Guo GB: Junctional tachycardia during radiofrequency ablation of the slow pathway in patients with AV nodal reentrant tachycardia: effects of autonomic blockade. J Cardiovasc Electrophysiol 1999; 10: 56-60 – reference: 6) Ehlert FA, Goldberger JJ, Deal BJ, et al: Successful radiofrequency energy ablation of automatic junctional tachycardia preserving normal atrioventricular nodal conduction. Pacing Clin Electrophysiol 1933; 16: 54-61 – reference: 10) Yu JC, Lauer MR, Young C, et al: Localization of the origin of the atrioventricular junctional rhythm induced during selective ablation of slow-pathway conduction in patients with atrioventricular node reentrant tachycardia. Am Heart J 1996; 131: 937-946 |
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| Snippet | 症例は46歳, 女性の発作性上室性頻拍(paroxysmal supraventricular tachycardia; PSVT) 症例. PSVTは心拍数107bpmで, QRSの終末部にP波を認めた. 心臓電気生理学的検査ではコントロールにて室房伝導は認めず, 頻拍は誘発不能.... |
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| Title | A case of junctional tachycardia cured by radiofrequency catheter ablation at the site of slow pathway area that was difficult to distinguish from common atrioventricular nodal reentrant tachycardia |
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