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 37(1): 35-41 (2021)

症例報告Case Report

心臓カテーテル検査中に想定外の心筋虚血から心停止に陥った心外膜リードによる心絞扼の1例Epicardial Pacemaker Lead-induced Cardiac Strangulation Causing Asystole due to Unexpected Myocardial Ischemia during Catheterization: A Case Report

1福岡市立こども病院 循環器科Department of Cardiology, Fukuoka Children’s Hospital ◇ Fukuoka, Japan

2福岡市立こども病院 心臓血管外科Department of Cardiovascular Surgery, Fukuoka Children’s Hospital ◇ Fukuoka, Japan

3福岡市立こども病院 放射線部Department of Radiology, Fukuoka Children’s Hospital ◇ Fukuoka, Japan

受付日:2020年3月17日Received: March 17, 2020
受理日:2020年9月7日Accepted: September 7, 2020
発行日:2021年4月1日Published: April 1, 2021


A 16-year-old male with complete congenital atrioventricular block since 1 year old was treated by epicardial pacemaker lead implantation. At 9 years old, he was diagnosed with supravalvular pulmonary artery stenosis resulting from epicardial pacemaker leads with cardiac strangulation as the possible cause. Transient ST change was seen only in the exercise tolerance test, with no chest pain, indicating that myocardial ischemia was absent. The deterioration status of supravalvular pulmonary artery stenosis was assessed by catheterization. With his arms raised, he was injected with a small amount of contrast media, suddenly, he lost consciousness. Electrocardiography showed ST segment alterations after frequent premature ventricular contractions, followed by junctional bradycardia that rapidly progressed to asystole. Hence, transient ischemia caused by arm raising or frequent premature ventricular contractions and deterioration of the coronary artery compression was suspected. The leads were then removed in an urgent surgery. In conclusion, contrast-enhanced computed tomography should be conducted in patients with cardiac strangulation, and earlier lead exchange should be performed because of the rapid deterioration of myocardial ischemia.

Key words: cardiac strangulation; pacemaker; congenital complete atrioventricular block

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