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 34(4): 172-181 (2018)


小児循環器領域の植え込み型心臓電気デバイスペースメーカ,植え込み型除細動器,心臓再同期療法Cardiac Implantable Electrical Devices in Pediatric Cardiology: Pacemaker, Implantable Cardioverter Defibrillator, and Cardiac Resynchronization Therapy

天理よろづ相談所病院小児循環器科・先天性心疾患センターDepartment of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital ◇ Nara, Japan

発行日:2018年12月20日Published: December 20, 2018

小児・先天性心疾患(CHD)を対象とする小児循環器領域の植え込み型心臓電気デバイス治療は,ペースメーカ(PM)が主流で,植え込み型除細動器(ICD)や心臓再同期療法(CRT)の適応は少ない.CHD非合併小児のPMは,体格が小さい場合心外膜リードを用いる.適応疾患は先天性完全房室ブロック(CCAVB)が多い.ICDの対象はQT延長症候群や肥大型心筋症が多いが,体重20~30 kg以下ではショックリードの植え込み方法に工夫を要する.CRTは,心筋症・CCAVBが多く,左室伝導遅延を伴う左室同期不全例には効果的であると考える.CHDでは,静脈アクセスが制限されている場合,心内シャントがある場合には心外膜リードを用いる.PMの適応には解剖,手術,血行動態の理解が必要で,PM設定は血行動態への影響が大きく,血行動態を評価しながら決定する.ICDの適応は,成人が多いが,心臓突然死一次予防については確立されたものはない.CRTは,心室形態・同期不全のパターンを加味してリード位置を決定する.

Among the cardiac implantable electrical devices used in pediatric cardiology, a pacemaker (PM) is mainly used rather than an implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT). For pediatric patients without a congenital heart disease (CHD), epicardial leads are commonly used because of the small body size. The most common indication for using a PM is congenital complete atrioventricular block (CCAVB). ICD implantation in patients who weigh <30 kg, mainly those with long QT syndrome or hypertrophic cardiomyopathy, shock leads are required to be implanted in a different manner than those in other adults. CRT is assumed to be effective in patients with left ventricular conduction delay and dyssynchrony, chiefly in those with CCAVB or cardiomyopathy. For CHD patients, epicardial leads are selected for those with limited venous access to the heart or the intracardiac shunt. PM implantation is considered based on the anatomy, operative procedure, and hemodynamics. The PM timing needs to be set while assessing the hemodynamics because it has a considerable impact on the hemodynamics of CHD patients. The indication for the use of ICD for the primary prevention of sudden cardiac death in CHD has not been established yet owing to the heterogeneous cardiac anatomy and lack of randomized clinical trials. For CRT, the pacing lead positions should be decided according to the ventricular morphology and the patterns of ventricular dyssynchrony.

Key words: pediatric; congenital heart disease; pacemaker; implantable cardioverter defibrillator; cardiac resynchronization therapy

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