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(1): 61-65 (2017)
doi:10.9794/jspccs.33.61

症例報告Case Report

カテコラミン誘発多形性心室頻拍に対するフレカイニド療法の運動負荷心電図所見と血中濃度の関係Association between Exercise Electrocardiography Findings and Blood Flecainide Concentrations in a Patient with Catecholaminergic Polymorphic Ventricular Tachycardia

1旭川医科大学小児科Department of Pediatrics, Asahikawa Medical University ◇ Hokkaido, Japan

2名寄市立総合病院小児科Department of Pediatrics, Nayoro City General Hospital ◇ Hokkaido, Japan

受付日:2016年10月24日Received: October 24, 2016
受理日:2016年12月16日Accepted: December 16, 2016
発行日:2017年1月1日Published: January 1, 2017
HTMLPDFEPUB3

カテコラミン誘発多形性心室頻拍(Catecholaminergic polymorphic ventricular tachycardia: CPVT)は小児の突然死の原因の一つである.CPVTの初期治療としてはβ遮断薬が推奨されているが,それのみでは致死的なイベントを完全に防ぐことはできない.フレカイニドはIc群の抗不整脈薬であり,近年β遮断薬と同様にCPVT患者での運動誘発性の心室性不整脈の発症を減少させ,心イベントを予防すると報告された.フレカイニドに対する不整脈の改善は用量依存性であるとされているが,CPVT患者においてフレカイニド血中濃度と運動負荷心電図との直接的な関係をみた報告はない.我々は,8歳のCPVT患者に対して,β遮断薬とフレカイニドで治療を行い,治療効果判定として運動負荷心電図とフレカイニド血中濃度の測定を繰り返し行った.患者は十分な効果を得るために高用量のフレカイニド内服を要した.CPVT患者の治療に当たる際に,血中濃度と運動負荷心電図を繰り返し行うことはフレカイニドの効果判定に重要である.

Catecholaminergic polymorphic ventricular tachycardia can cause sudden cardiac death in children. Administration of β-blockers is the first-line therapy for catecholaminergic polymorphic ventricular tachycardia but does not completely prevent cardiac or fetal events. Similar to β-blockers, flecainide, a class I sodium channel blocker, has recently been reported to reduce the occurrence of exercise-induced ventricular arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia and prevent cardiac events. Changes in the electrocardiogram are proportional to the dosage of flecainide. However, no reports have investigated the association between exercise electrocardiography and blood flecainide concentrations in patients with catecholaminergic polymorphic ventricular tachycardia.

We report a case of catecholaminergic polymorphic ventricular tachycardia in an 8-year-old boy who was treated with β-blockers and flecainide. We used exercise electrocardiography to evaluate the treatment results and measured blood flecainide concentrations several times. We found that our patient required high doses of flecainide to achieve a sufficient therapeutic effect. Our case supports the requirement for exercise electrocardiography and repeated measurements of blood flecainide concentrations when treating children with catecholaminergic polymorphic ventricular tachycardia.

Key words: catecholaminergic polymorphic ventricular tachycardia; flecainide; exercise electrocardiography

This page was created on 2016-12-28T13:30:48.042+09:00
This page was last modified on 2017-02-06T10:48:59.471+09:00


このサイトは(株)国際文献社によって運用されています。