medicina53巻5号

2016年04月発行

特集 心電図を詠む—心に残る24症例から 不整脈

心電図が足を引っ張った症例

著者： 齋藤雄司¹

所属機関： ¹

ページ範囲：P.684 - P.688

ポイント
●現場の心電図はいつも教科書通りではない．柔軟な思考が患者を助ける．
●同僚，コメディカルの心電図解釈には常に真摯に耳を傾ける．一歩立ち止まって「そうかもしれない」と考える余裕をもつ．
●患者への心電図説明も積極的に行う．信頼関係構築に役立つ．

参考文献

1）Sharma AD, et al：Atrial fibrillation in patients with Wolff-Parkinson-White syndrome；Incidence after surgical ablation of the accessory pathway. Circulation 72：161-169, 1985　心房細動既往のあるWPW症候群患者19例の手術的アブレーション後の追跡調査．約2年間のフォローアップ中，心房細動再発は1例のみ．

2）Haissaguerre M, et al：Frequency of recurrent atrial fibrillation after catheter ablation of overt accessory pathways. Am J Cardiol 69：493-497, 1992

3）Wathen M, et al：Initiation of atrial fibrillation in theWolff-Parkinson-White syndrome；The importance of the accessory pathway. Am Heart J 125：753-759, 1993

4）Szumowski L, et al：Predictors of the atrial fibrillation occurrence in patients with Wolff-Parkinson-White syndrome. Kardiol Pol 67：973-978, 2009

5）Oddsson H, et al：Episodes of atrial fibrillation and atrial vulnerability after successful radiofrequency ablation in patients with Wolff-Parkinson-White syndrome. Europace 4：201-206, 2002

6）Dagres N, et al：Impact of radiofrequency catheter ablation of accessory pathways on the frequency of atrial fibrillation during long-term follow-up. High recurrence rate of atrial fibrillation in patients older than 50 years of age. Eur Heart J 22：423-427, 2001　心房細動既往のあるWPW症候群患者116例の高周波アブレーション後の追跡調査．約3年間のフォローアップ中，心房細動再発率は年齢とともに上昇．50歳以下で12％，50〜60歳で35％，60歳以上では55％に心房細動再発が認められた．

7）Centurion OA, et al：Mechanisms for the genesis of paroxysmal atrial fibrillation in the Wolff-Parkinson-White syndrome：Intrinsic atrial muscle vulnerability vs. electrophysiological properties of the accessory pathway. Europace 10：294-302, 2008

8）Chen Y-J, et al：Role of atrial electrophysiology and autonomic nervous system in patients with supraventricular tachycardia and paroxysmal atrial fibrillation. J Am Coll Cardiol 32：732-738, 19989）Hamada T, et al：Mechanisms for atrial fibrillation in patients with Wolff-Parkinson-White syndrome. J Cardiovasc Electrophysiol 13：223-229, 2002

9）Hamada T, et al：Mechanisms for atrial fibrillation in patients with Wolff-Parkinson-White syndrome. J Cardiovasc Electrophysiol 13：223-229, 2002

10）Della Bella P, et al：Atrial fibrillation in patients with an accessory pathway；Importance of the conduction properties of the accessory pathway. J Am Coll Cardiol 17：1352-1356, 1991