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
Pediatric Cardiology and Cardiac Surgery 31(6): 322-328 (2015)


ICD植込みの実際AEDで蘇生された先天性心疾患症例6例の検討Clinical Strategy for the Use of Implantable Cardioverter Defibrillators: The Outcome in Six Patients with Congenital Heart Disease Who Were Resuscitated Using an Automated External Defibrillator

1公益財団法人日本心臓血圧研究振興会附属榊原記念病院小児循環器科Department of Pediatric Cardiology, Sakakibara Heart Institute, Japan Research Promotion Society for Cardiovascular Diseases ◇ 〒183-0003 東京都府中市朝日町三丁目16番1号Asahi-cho 3-16-1, Fuchu-shi, Tokyo 183-0003, Japan

2公益財団法人日本心臓血圧研究振興会附属榊原記念病院循環器内科Department of Cardiology, Sakakibara Heart Institute, Japan Research Promotion Society for Cardiovascular Diseases ◇ 〒183-0003 東京都府中市朝日町三丁目16番1号Asahi-cho 3-16-1, Fuchu-shi, Tokyo 183-0003, Japan

3医療法人社団心臓画像クリニック飯田橋Cardiovascular Imaging Clinic (CVIC) Iidabashi ◇ 〒162-0814 東京都新宿区新小川町1番14号 飯田橋リープレックス・ビズ4階Iidabashi Reeplex B's 4F, Shin-Ogawa-machi 1-14, Shinjuku-ku, Tokyo 162-0814, Japan

受付日:2015年3月12日Received: March 12, 2015
受理日:2015年9月8日Accepted: September 8, 2015
発行日:2015年11月1日Published: November 1, 2015

背景:公共機関の自動体外式除細動器(AED)設置が一般化しつつあり,AEDによるVF survivorの予後に感心が高まっている.しかし先天性心疾患(CHD)を基礎にもつVF survivorの蘇生後経過に関してはほとんど報告がない.



結論:当院ではCHDを基礎にもつVF survivorの診療において,VFの原因となる血行動態の問題点を積極的に治療し,ICD植込みを併行して行う方針としている.全例後遺症なく生存しており,有効な治療戦略と考える.

Background: Increasing number of automated external defibrillators (AED) has been installed in public institutions nationwide. Therefore, there is increasing interest in the prognosis of patients who survived after incidences of ventricular fibrillation (VF) and were resuscitated using AEDs. However, little information is available about VF survivors with congenital heart disease (CHD).

Methods: Six CHD patients (median age: 17.1 years), who were resuscitated using an AED and subsequently underwent implantable cardioverter defibrillator (ICD) implantation in our hospital between November 2006 and October 2012, were reviewed. Patient demographics and periprocedural data of the ICD were analyzed.

Results: Underlying diseases consisted of two patients with tetralogy of Fallot and one each of corrected transposition of the great arteries, subaortic stenosis, myocardial infarction post-surgery for congenital mitral regurgitation, and anomalous origin of the coronary artery. In five patients, repair of the cardiac abnormality was simultaneously performed with the ICD implantation. During a median follow-up period of 3.9 years, one patient received appropriate therapy (once) and three patients received inappropriate therapies (eight times in total).

Conclusions: Here we reported on our strategy and the clinical outcome of VF survivors with CHD who underwent ICD implantation at our hospital. Our treatment policy for ventricular tachycardia/VF includes aggressive intervention of the underlying cardiac abnormality and jeopardized hemodynamics using cardiac medications and surgery in addition to ICD implantation. As a result of this useful strategy, all patients are still alive without residual disability.

Key words: implantable cardioverter defibrillator; automated external defibrillator; ventricular fibrillation; congenital heart disease

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