先天性心疾患における着用型自動除細動器（WCD）の使用経験

Tomomi Nishimura; 西村智美; Keiko Toyohara; 豊原啓子; Kei Inai; 稲井慶; Tokuko Shinohara; 篠原徳子; In Sam Park; 朴仁三; Morio Shoda; 庄田守男

doi:10.9794/jspccs.33.228

先天性心疾患における着用型自動除細動器（WCD）の使用経験A Wearable Cardioverter Defibrillator for Patients with Congenital Heart Disease: A Report of Two Cases

西村智美¹，豊原啓子¹，稲井慶^1,2，篠原徳子^1,2，朴仁三¹，庄田守男^3,4Tomomi Nishimura¹, Keiko Toyohara¹, Kei Inai^1,2, Tokuko Shinohara^1,2, In Sam Park¹, Morio Shoda^3,4

¹ 東京女子医科大学循環器小児科Department of Pediatric Cardiology, Tokyo Women’s Medical University ◇ Tokyo, Japan

² 東京女子医科大学成人先天性心疾患病態学研究部門Department of Pediatric Cardiology, Division of Adult Congenital Heart Disease Pathophysiology and Lifelong Care, Tokyo Women’s Medical University ◇ Tokyo, Japan

³ 東京女子医科大学循環器内科Department of Cardiology, Tokyo Women’s Medical University ◇ Tokyo, Japan

⁴ 東京女子医科大学先進電気的心臓制御研究部門Clinical Research Division for Heart Rhythm Management, Tokyo Women’s Medical University ◇ Tokyo, Japan

受付日：2016年12月7日Received: December 7, 2016

受理日：2017年3月23日Accepted: March 23, 2017

発行日：2017年5月1日Published: May 1, 2017

着用型自動除細動器 WCD（旭化成ZOLL Medical社製：LifeVest®）は，2014年に保険償還され，国内での使用が開始された．当科で成人先天性心疾患（CHD）2症例に対しWCD導入を経験したので報告する．

症例1は，Fallot四徴症（TOF），Rastelli手術後の35歳女性．第一子分娩後に血圧低下，前失神発作を伴う非持続性心室頻拍（VT）を認めたが，VTに対する治療を拒否された．今回，第二子妊娠を契機に突然死予防目的でWCDを使用した．症例2は，TOF, Rastelli手術後の37歳女性．通勤中に心肺停止となり心肺蘇生が開始され，心室細動（VF）に対しAEDが作動し心拍は再開した．致死性不整脈が原因と考えられたが，直ちに植込み型除細動器（ICD）を植込むことを拒否したため，待機期間中にWCDを使用した．2症例の1日平均着用時間はそれぞれ8時間と18時間で，使用期間中にVT/VFは出現することなく経過しショックによる作動も認めなかった．

着用のみで非侵襲的に使用可能なWCDは，今後CHD症例においても突然死を予防するために需要が高まると思われる．

The wearable cardioverter defibrillator (WCD) used by patients at risk of sudden cardiac arrest has been available in Japan since 2014. Here, we report two cases of congenital heart disease (CHD) in patients who wore a WCD.

Case 1: A 35-year-old woman with tetralogy of Fallot (TOF) following the Rastelli procedure had symptomatic non-sustained ventricular tachycardia (VT) during her puerperium with her first child. However, she refused treatment for VT. She eventually became pregnant with her second child. The indications for a WCD were risk management of VT, which developed in the third trimester.

Case 2: A 37-year-old woman with TOF following the Rastelli procedure survived a cardiopulmonary arrest due to ventricular fibrillation revealed by an automated external defibrillator (AED). The indication for a WCD was bridging therapy for an implantable cardioverter defibrillator (ICD).

The WCD was used daily for 8 hours by the first patient and for 18 hours by the second patient. No cardiac events occurred while using the WCD; neither patient received shock therapy as a result of using the device.

Based on our limited experience, WCDs are useful for patients with CHD and do not cause serious complications.

Key words: congenital heart disease; wearable cardioverter defibrillator; ventricular tachycardia; implantable cardioverter defibrillator

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

症例報告Case Report

先天性心疾患における着用型自動除細動器（WCD）の使用経験A Wearable Cardioverter Defibrillator for Patients with Congenital Heart Disease: A Report of Two Cases