ºÎÁ¤¸ÆV10N³»Áö

Size: px

Start display at page:

Download "ºÎÁ¤¸ÆV10N³»Áö"

소이 공
5 years ago
Views:

A case of nonischemic dilated cardiomyopathy with ventricular tachycardia treated by ICD ABSTRACT Dilated cardiomyopathy (DCM) is a syndrome characterized by left or biventricular dilatation and

1 A case of nonischemic dilated cardiomyopathy with ventricular tachycardia treated by ICD ABSTRACT Dilated cardiomyopathy (DCM) is a syndrome characterized by left or biventricular dilatation and impaired systolic function. ICD (implantable cardioverter defibrillator) is superior to anti-arrhythmic drugs in secondary prevention of overall death and SCD in the general HF population. Similar results were also shown in primary prevention in ischemic DCM. We experienced 50 years old man presented as non-ischemic dilated cardiomyopathy with ventricular tachycardia. ICD was inserted as secondary prevention. But in spite of ICD insertion, patient has developed aggravation of heart failure during 2 years of follow up. Key words: nonischemic dilated cardiomyopathy EF (ejection fraction) ICD Correspondence: Dae-Kyeong Kim, MD, Division of Cardiology, Department of Internal Medicine, College of Medicine, The Inje University of Korea, , kaekeum-dong, Busanjin-Gu , Busan, Korea Tel: , Fax: epkimdk@yahoo.co.kr 47

2 Figure 1. Electrocardiogram from a local clinic shows a wide QRS tachycardia cardioverted to NSR after shock. 48 Journal of Cardiac Arrhythmia

차이가 없다고 보고한 바 있다. 그렇지만 심실 구혈률에 의 의하여, III, IV 환자들은 심부전의 악화에 의한 경우가 많 한 예측치가 가장 높다는데 이의가 없는 것 같다. 1990년대 1 다고 한다.

이는 수축기 기능의 회복이 중요한 역할을 한다 급사의 위험 정도를 평가하는 여러 연구가 시도되었으나, 는 반증이 된다.

3 차이가 없다고 보고한 바 있다. 그렇지만 심실 구혈률에 의 의하여, III, IV 환자들은 심부전의 악화에 의한 경우가 많 한 예측치가 가장 높다는데 이의가 없는 것 같다. 1990년대 1 다고 한다. QT dispersion, T wave alternance, heart 이후 ACE 억제제와 베타차단제의 사용으로 생존율이 향상 rate variations, signal average EKG, 전기생리학 검사 등 되었는데, 이는 수축기 기능의 회복이 중요한 역할을 한다 급사의 위험 정도를 평가하는 여러 연구가 시도되었으나, 는 반증이 된다. 폐동맥압의 상승은 LV filling pressure의 연구결과마다 차이가 있고 그 유용성에 대해서도 의견이 다 backward transmission과 혈관저항 증가로 설명될 수 있 2 양하다. Grimm 등 은 NICM 환자에서는 전기생리학 검사 다. 전통적으로 폐모세혈관 쐐기압(pulmonary capillary 에서 부정맥이 유발되어도 유발되지 않은 군과 급사 발생은 wedge pressure, PCWP)가 예후를 반영하는 주요한 혈역 A 며, NYHA functional class I, II의 환자는 주로 부정맥에 B Figure 2. The coronary angiogram does not show any significant lesion. Figure 3. Ventricular tachycardia (RBRS) inducted at a cycle length of 500/24/210/

A B Figure 4. The change of mitral inflow from pseudonormal (A) to restrictive pattern (B). < < < References 1. Sugrue DD, Rodeheffler RJ, Codd MB, Billard DJ, Fuster V, Gersh BJ.

Programmed venticular stimulation for arrhythmia risk prediction in patients with idiopathic dilated cardiomyopathy and nonsustained ventricular tachycardia. J Am Coll Cardiol. 1998;32:739-745. 3.

4 A B Figure 4. The change of mitral inflow from pseudonormal (A) to restrictive pattern (B). < < < References 1. Sugrue DD, Rodeheffler RJ, Codd MB, Billard DJ, Fuster V, Gersh BJ. The clinical course of idiopathic cardiomyopathy: a population-based study., Ann Intern Med. 1992;117: Grimm W, Hoffmann J, Menz V, Luck K, Maisch B. Programmed venticular stimulation for arrhythmia risk prediction in patients with idiopathic dilated cardiomyopathy and nonsustained ventricular tachycardia. J Am Coll Cardiol. 1998;32: Ghio S. Pulmonary hypertension in advanced heart failure. Herz. 2005;30: Gavazzi A, Ghio S, Scelsi L, Campana C, Klersy C, Serio A, Raineri C, Tavazzi L. Response of the right ventricle to acute pulmonary vasodilation predicts the outcome in patients with advanced heart failure and pulmonary hypertension. Am Heart J. 2003;145: Strickberger SA, Hummel JD, Bartlett TG, Frumin HI, Schuger SL, Bitar C, Morady F; AMIOVIRT Investigatora. Amiodarone versus implantable cardioverter-defibrillator: randomized trial in patients with nonischemic dilated cardiomyopathy and asymptomatic nonsustained ventricular tachycardia-amiovert. J Am Coll Cardiol. 2003;41: Bansch D, Antz M, Boczor S Volkmer M, Tebbenjohanns J, Seidl K, Block M, Geitzen F, Berger J, Kuck KH. Primary prevention of 50 Journal of Cardiac Arrhythmia

5 sudden cardiac death in idiopathic dilated cardiomyopathy: the Cardiomyopathy Trial (CAT). Circulation. 2002;105: Kadish A, Dyer A, Daubert JP, Quigg R, Estes NA, Anderson KP, Calkins H, Hoch D, Goldberger J, Shalaby A, Sanders WE, Schaechter A, Levine JH; Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE) Investigators. Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med. 2004;350: Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, Domanski M, Troutman C, Anderson J, Johnson G, McNulty SE, Clapp-Channing N, Davidson-Ray LD, Fraulo ES, Fishbein DP, Luceri RM, Ip JH; Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005;352:

<303520C1BEBCB320B9DAC7FCBCB72DC7D1BCBABFED2E687770>

<303520C1BEBCB320B9DAC7FCBCB72DC7D1BCBABFED2E687770> 대한내과학회지 : 제 90 권제 2 호 2016 http://dx.doi.org/10.3904/kjm.2016.90.2.115 종설 (Review) 돌연사의일차적예방을위한삽입형제세동기치료 계명대학교동산의료원심장내과 박형섭 한성욱 Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden