Wolff–Parkinson–White症候群における心室早期興奮が心機能に及ぼす影響

Shuhei Fujita; 藤田修平; Ryo Nakagawa; 中川亮; Keigo Nishida; 西田圭吾; Akira Sato; 佐藤啓; Kazuo Usuda; 臼田和生; Keiichi Hirono; 廣野恵一; Fukiko Ichida; 市田蕗子; Takeshi Futatani; 二谷武; Noboru Igarashi; 五十嵐登; Kiyoshi Hatasaki; 畑崎喜芳

doi:10.9794/jspccs.34.63

Wolff–Parkinson–White症候群における心室早期興奮が心機能に及ぼす影響Effect of Ventricular Preexcitation on Left Ventricular Function in Pediatric Patients with Wolff–Parkinson–White Syndrome

藤田修平¹，中川亮¹，西田圭吾¹，佐藤啓¹，臼田和生²，廣野恵一³，市田蕗子³，二谷武¹，五十嵐登¹，畑崎喜芳¹Shuhei Fujita¹, Ryo Nakagawa¹, Keigo Nishida¹, Akira Sato¹, Kazuo Usuda², Keiichi Hirono³, Fukiko Ichida³, Takeshi Futatani¹, Noboru Igarashi¹, Kiyoshi Hatasaki¹

¹ 富山県立中央病院小児科Department of Pediatrics, Toyama Prefectural Central Hospital ◇ Toyama, Japan

² 富山県立中央病院内科（循環器）Department of Internal medicine, Toyama Prefectural Central Hospital ◇ Toyama, Japan

³ 富山大学医学部小児科Department of Pediatrics, University of Toyama Graduate School of Medicine ◇ Toyama, Japan

受付日：2017年11月22日Received: November 22, 2017

受理日：2018年2月14日Accepted: February 14, 2018

発行日：2018年3月1日Published: March 1, 2018

背景：WPW症候群において頻回の頻拍発作がない症例で，副伝導路に起因すると思われる拡張型心筋症が報告されている．

目的：顕性副伝導路による心室早期興奮の心機能に対する影響に関して検討する．

対象と方法：対象は発作性上室性頻拍に対して心臓電気生理学的検査およびカテーテルアブレーション（RFA）を行った房室回帰性頻拍の20症例（男：女＝8 : 12, 年齢12（0.8～16）歳）．術前に副伝導路による心室早期興奮を認めた群（顕性群12例）と認めなかった群（潜在性群8例）で比較検討した．

結果：RFA前の左室駆出率はいずれの群も正常範囲であったが顕性群で有意に低値であった（顕性群vs. 潜在性群66.0 (47.7～74.5) vs. 78.1 (70.1～83.0)％, p＝0.001）．左室駆出率は顕性群でRFA後に上昇した（前vs. 後66.0 (42.7～74.5) vs. 74.4 (52.7～80.7)％, p＝0.003）．潜在性群では左室駆出率の変化はなかった（前vs. 後78.1 (70.1～83.0) vs. 79.3 (72.1～85.2)％, p＝0.58）．心機能低下例を2例認め，左室駆出率はそれぞれ53.1, 42.7％であった．いずれも顕性群であり副伝導路は右後側壁および右前側壁副伝導路であった．RFA後に左室駆出率はそれぞれ75.7, 52.7％まで改善した．

結論：顕性副伝導路症例では潜在性副伝導路症例に比べて左室駆出率が低値であり，顕性副伝導路の消失により左室駆出率は上昇することが示された．

Background: Wolff–Parkinson–White syndrome with ventricular preexcitation may cause cardiac dysfunction and dilated cardiomyopathy even in the absence of recurrent and incessant tachycardia.

Purpose: This study aimed to determine the effect of ventricular preexcitation on cardiac function in pediatric patients with manifest accessory pathway.

Methods: We analyzed the clinical data of 20 patients who underwent electrophysiological examination and radiofrequency catheter ablation (RFA) for paroxysmal supraventricular tachycardia associated with accessory pathway [male : female, 8 : 12; age, 12 (0.8～16) years]. We divided the patients into two groups: patients with ventricular preexcitation (manifest group, n＝12) and those without ventricular preexcitation (concealed group, n＝8).

Results: LVEF before RFA was within the normal range in all patients but was significantly lower in the manifest group than in the concealed group [manifest group vs. concealed group, 66.0％ (47.7％–74.5％) vs. 78.1％ (70.1％–83.0％); p＝0.001]. LVEF increased after RFA in the manifest group [prior-RFA vs. post-RFA, 66.0％ (42.7％–74.5％) vs. 74.4％ (52.7％–80.7％); p＝0.003]. No change was observed in the LVEF after RFA in the concealed group. Cardiac dysfunction was detected in two patients, with the LVEF of 53.1％ and 42.7％, respectively. Both patients were in the manifest group, and the accessory pathway was located at the right posterolateral and right anterolateral, respectively. The LVEF after RFA in these patients improved to 75.7％ and 52.7％, respectively.

Conclusions: The LVEF was lower in patients with manifest accessory pathway than in patients with concealed accessory pathway, and the LVEF was shown to increase by the disappearance of preexcitation of the manifest accessory pathway.

Key words: Wolff–Parkinson–White syndrome; ventricular preexcitation; dilated cardiomyopathy; radiofrequency catheter ablation; cardiac function

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

原著Original

Wolff–Parkinson–White症候群における心室早期興奮が心機能に及ぼす影響Effect of Ventricular Preexcitation on Left Ventricular Function in Pediatric Patients with Wolff–Parkinson–White Syndrome