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, 633-165, kaekeum-dong, Busanjin-Gu 614-735, Busan, Korea Tel: 82-51-890-6402, Fax: 82-51-892-0273 E-mail: epkimdk@yahoo.co.kr 47
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. 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 500/24/210/230. 49
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