日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Pediatric Cardiology and Cardiac Surgery 31(4): 199-204 (2015)
doi:10.9794/jspccs.31.199

症例報告Case Report

良性心室期外収縮として長期経過観察中に発症した特発性多形性右室流出路起源心室頻拍の1男児例Idiopathic Polymorphic Right Ventricular Outflow Tachycardia Developed after a Long-term Follow-up of Benign Premature Ventricular Contractions with a Normal Structural Heart

1大阪市立総合医療センター小児医療センター小児不整脈科Department of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital ◇ 〒534-0021 大阪府大阪市都島区都島本通2丁目13番22号2-13-22 Miyakojima Hon-dori, Miyakojima-ku, Osaka-shi, Osaka 534-0021, Japan

2大阪市立総合医療センター小児医療センター小児循環器内科Department of Pediatric Cardiology, Pediatric Medical Care Center, Osaka City General Hospital ◇ 〒534-0021 大阪府大阪市都島区都島本通2丁目13番22号2-13-22 Miyakojima Hon-dori, Miyakojima-ku, Osaka-shi, Osaka 534-0021, Japan

3近畿大学医学部小児科学教室Department of Pediatrics, Faculty of Medicine, Kinki University ◇ 〒589-8511 大阪府大阪狭山市大野東377番2号377-2 Ono-Higashi, Osaka Sayama-shi, Osaka 589-8511, Japan

受付日:2014年11月14日Received: November 14, 2014
受理日:2015年4月20日Accepted: April 20, 2015
発行日:2015年7月1日Published: July 1, 2015
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患者は特記すべき既往歴や家族歴のない11歳男児.6歳時の学校心臓検診で心室期外収縮と診断され,運動負荷による消失を確認後,年1回経過観察されていた.9歳頃から動悸を自覚,11歳時に頻度が増加し,検診時に自覚症状が初めて明らかとなった.Holter心電図で心室期外収縮は全心拍数の25%,最長50秒の持続性心室頻拍を認め,治療目的で紹介され入院となった.入院時偶発的にリンパ節炎で発熱を認めた.心エコー上,基礎心疾患なく心機能は正常だった.多発する多形性非持続性心室頻拍は,強い動悸の症状を伴った.Landiolol持続静注開始により二段脈まで改善,感染症の治癒後に電気生理検査およびカテーテルアブレーション治療を施行した.右室流出路肺動脈弁直下の不整脈起源に対する高周波通電で不整脈は消失した.術後1年半の経過観察期間で再発はない.小児の心室期外収縮・心室頻拍は単形性の右室流出路起源のものが多く,自然予後は良好である.しかしながら,極めてまれに多形性心室頻拍や心室細動にいたる一群が潜在する.多形性心室頻拍の早期発見のためには,学校検診後の経過観察中であっても,自覚症状の出現に特に注意して問診を行う必要がある.

A 6-year-old asymptomatic boy without structural heart disease was revealed by a school-based heart disease screening to have isolated premature ventricular contractions (PVCs). After confirming the disappearance of PVCs by exercise stress test, he was followed up once a year. Three years after the initial diagnosis, he experienced palpitations and dimmed vision but without syncope. At 11 years of age, he was diagnosed with repetitive and sustained ventricular monomorphic tachycardia. On admission, he had fever due to an upper respiratory tract infection. His palpitations were severe, and his 12-lead electrocardiogram showed polymorphic ventricular tachycardia of right ventricular origin. After continuous infusion of an ultra-short-acting beta blocker, his ventricular tachycardia improved to maximal bigeminal premature contractions. Electrophysiological examination was performed under general anesthesia. This showed that tachycardia arose from the posterior free wall of right ventricular outflow tract. To target the initial PVC, radiofrequency ablation was successfully performed with an irrigated ablation catheter. Observation over 18 months following ablation showed no recurrence of ventricular tachycardia and symptoms. Although PVCs that originate from the right ventricular outflow tract in children with normal structural hearts usually carry a good prognosis, there are rare cases that involve polymorphic ventricular tachycardia with symptoms. In the follow-up of children with PVCs identified in school heart screenings, we must pay attention to the manifestation of symptoms for earlier detection of malignant arrhythmias.

Key words: premature ventricular contraction; idiopathic polymorphic ventricular tachycardia; school heart examination; malignant entity of idiopathic right ventricular outflow tachycardia

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