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 36(4): 321-327 (2020)
doi:10.9794/jspccs.36.321

症例報告Case Report

多源性心房頻拍により心原性ショックに陥った不整脈誘発性心筋症の4か月乳児例Arrhythmia-Induced Cardiomyopathy Presented Cardiogenic Shock Caused by Multifocal Atrial Tachycardia in a 4-Month-Old Boy

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富山大学附属病院 小児科Department of Pediatrics, Graduate School of Medicine, University of Toyama ◇ Toyama, Japan

受付日:2019年12月10日Received: December 10, 2019
受理日:2020年4月17日Accepted: April 17, 2020
発行日:2020年12月1日Published: December 1, 2020
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多源性心房頻拍は乳児期に発症し,頻拍がインセサントとなることで,不整脈誘発性心筋症に陥ることがある.乳児では自覚症状を訴えることがなく,症状が進行してから発見されることが多い.症例は4か月の男児.4か月健診での脈の不整および頻脈を指摘され紹介となった.来院時,顔色不良,末梢冷感を認めた.胸部レントゲンでは心胸郭比65%,肺うっ血を伴っていた.心電図では多源性のP波を認め,HR 220~240 bpmの不規則な心拍であり,多源性心房頻拍と診断した.心臓超音波検査では著明な心機能低下と左室拡大(左室拡張末期径30.0 mm, 130% of Normal)を認めた.まず頻拍の停止,心拍数低下を目的にアミオダロンを静注投与したところ心拍数の低下は認めたが,血圧低下を来したため,気管挿管,カテコラミン投与で治療を開始した.頻拍はアミオダロン,ランジオロール,アプリンジン投与で洞調律となった.洞調律復帰後に徐々に心機能は改善し,不整脈誘発性心筋症と診断した.抗不整脈薬による頻拍のコントロールが可能であれば,不整脈誘発性心筋症は心機能の改善が期待できる.

Multifocal atrial tachycardia (MAT) is generally diagnosed in infants under one year of age; a few of these infants may also present with arrhythmia-induced cardiomyopathy. We report the case of 4-month-old boy diagnosed with cardiogenic shock secondary to MAT who responded to antiarrhythmic medications. The child was delivered by caesarean section at gestational age of 36 weeks due to fetal distress; his birth weight was 2,362 g. He was referred to our hospital at four months of age with chief complaints of poor feeding and tachyarrhythmias detected during a previous examination. A 12-lead electrocardiogram (ECG) revealed a narrow QRS complex and irregular tachycardia at a rate of 200–240 beats per minute, leading to the diagnosis of MAT. Echocardiography revealed severe functional decline, including an 11% shortening fraction (SF) and a dilated left ventricle. Amiodarone (5 mg/kg injection) was administered in an attempt to normalize the atrial tachycardia; this resulted in a substantial drop in blood pressure. The patient was intubated and provided with inotropic support, including dopamine and milrinone. Landiolol (10 µg/kg/min by continuous infusion) and oral aprindine (1.5 mg/kg/day) were initiated on hospital day 8. The frequency of tachycardia decreased and cardiac function gradually recovered over a period of 2–3 weeks. The patient was discharged on hospital day 43 with improved cardiac function and a SF of 30%. Results from a follow-up visit revealed the cardiac function had returned to near-normal with no recurrence of MAT. We conclude that it is critical to control MAT in pediatric patients with arrhythmia-induced cardiomyopathy.

Key words: multifocal atrial tachycardia; arrhythmia-induced cardiomyopathy; infant; acute heart failure

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