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 33(2): 125-134 (2017)
doi:10.9794/jspccs.33.125

ReviewReview

不整脈:学校心臓検診で診断される不整脈の管理と治療The Management and Therapy for Arrhythmias Extracted from School-based Cardiovascular Screening

大阪市立総合医療センター小児不整脈科Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital ◇ Osaka, Japan

発行日:2017年3月1日Published: March 1, 2017
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学校心臓検診で抽出される不整脈は無自覚・無症状の疾患がその大勢を占め,その管理に苦慮することは多い.本稿では学校心臓検診で抽出される,心室性期外収縮(PVC),QT延長症候群(LQT),WPW症候群について概説する.PVCは多くが治療介入の必要がない良性の不整脈である.カテコラミン誘発性多型心室頻拍(CPVT)の鑑別が問題となるが,CPVTは安静時PVCを認めないことが多く検診で抽出されるPVCにCPVTが含まれることは稀である.LQTはトレッドミル検査やホルター検査で精査を行う.補正式はFridericia補正が推奨されている.LQTが疑われる場合,運動制限,予防内服治療,遺伝子検査について検討が必要となる.WPWはΔ波で診断される心房と心室をつなぐ副伝導路による疾患だが,Δ波を有する早期興奮症候群の中で束枝と心室をつなぐ副伝導路(FVP)との鑑別が問題となる.FVPは頻拍発作や突然死のリスクのない疾患であり,疾患概念を理解しておくことは重要である.

Arrhythmias extracted from school-based cardiovascular screening accounts for a large number of asymptomatic diseases, and there are many cases where it is difficult to manage them. In this article, we outline the premature ventricular contractions (PVCs), long QT syndrome (LQT), and WPW syndrome extracted from school-based cardiovascular screening. PVCs are a form of benign arrhythmia, many of which do not require drug treatment or intervention. Although a differential diagnosis of catecholamine-induced polymorphic ventricular tachycardia (CPVT) is problematic, CPVT does not often exhibit PVCs at rest, and it is rarely is CPVT detected by PVCs extracted by screening. LQT is examined by treadmill tests and Holter recordings. The Fridericia correction is recommended for the correction formula. If LQT is suspected, exercise limitations, preventive medication, and genetic testing should be considered. Although WPW is a disease caused by an accessory pathway connecting the atrium and ventricle diagnosed by a Δ wave, the distinction between a fasciculoventricular pathway (FVP) and WPW syndrome becomes problematic. FVPs are a disease free from the risk of tachycardias and sudden death and it is important to understand the concept of the disease.

Key words: school-based cardiovascular screening; premature ventricular contraction; long QT syndrome; WPW syndrome; fasciculoventricular pathway

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