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(6): 322-328 (2015)
doi:10.9794/jspccs.31.322

原著Original

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
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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.

方法:2006年11月から2012年10月にAEDで蘇生され当院で植込み型除細動器(ICD)植込みを施行されたCHD症例(年齢中央値17.1歳)6例に関して患者背景,ICD作動状況等を検討した.

結果:基礎疾患はファロー四徴症2例,修正大血管転位症,大動脈弁下狭窄,先天性僧帽弁逆流術後心筋梗塞,冠動脈起始異常が各1例であった.ICD植込みと併行し外科治療介入が5例で行われた.ICD作動状況は追跡期間中央値3.9年で適切作動1例(1回),不適切作動3例(合計8回)であった.全例後遺症なく社会生活に復帰し,追跡期間中死亡例は認めなかった.

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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This page was last modified on 2015-11-27T14:20:29.601+09:00


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