Key result
AV sequential pacing improves symptoms and cardiac output in a patient with restrictive cardiomyopathy.
Why the study?
Restrictive cardiomyopathy is a relatively rare disease in Japan with limited detailed reports on abnormal Q waves, wall motion abnormalities, arrhythmias, and treatment with AV sequential pacing in cases with bradycardia-tachycardia syndrome.
Case Report (n=1)
AV sequential pacing can be an effective treatment for improving symptoms and cardiac output in patients with restrictive cardiomyopathy complicated by conduction disorders and bradycardia-tachycardia syndrome.
May support AV sequential pacing in select restrictive cardiomyopathy cases with conduction disorders; hypothesis-generating single case, needs prospective validation.
症例は45才,女性.半年前からの動悸およびめまい発作のため入院した.胸部X線像上CTRは57%で,心電図ではI・aVL・V4-6の異常Q波と著明な左軸偏位を伴う心室内伝導障害がみられた.心筋梗塞又は心筋症の疑いで心血管造影を施行し,左室心尖部のakinesisをみとめたが,冠動脈は正常であつた.左室の拡大はみられなかつたが, LVEDP 36mmHg・CI 2.08l/min/m2と高度の心機能低下を示した.右室心筋生検では, amyloidその他の沈着は認めなかつたが,中等度の心内膜の肥厚を示し, endomyocardial diseaseによる拘束型心筋症と診断した. Holter心電図で発作性心房細動を認めたため, digitalis・disopyramideを投与したところ,最高7秒の心停止を頻発した. RA pacingによる心拍出量の改善が著明であり,かつ伝導障害を伴うため, AV sequential pacingを行ない,症状改善に非常に有効であつた.拘束型心筋症は,本邦では比較的まれな疾患であり,異常Q波・壁運動異常や不整脈の合併に関する詳細な記載はほとんどみられない.異常Q波の成因や,徐脈を伴う本症におけるAV sequential pacingの利点などにつき,文献的考察を加え報告する.
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Hamashige et al. (1984) conducted a case report in Restrictive cardiomyopathy with abnormal Q wave and bradycardia-tachycardia syndrome (n=1). AV sequential pacing was evaluated on Symptom improvement. AV sequential pacing was highly effective in improving symptoms and cardiac output in a 45-year-old woman with restrictive cardiomyopathy and bradycardia-tachycardia syndrome.
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