Disopyramide for Transient High-degree Atrioventricular Block in a Young Patient with a history of Syncope <Case report>

一過性高度房室ブロックと失神の既往を持つ若年患者へのジソピラミド投与 <症例報告>

Hirai Yukoh

Yamamoto Hideya

Nakano Yukiko

Ogi Hiroshi

Kajiwara Shinji

Kohno Nobuoki

Journal of Cardiology

失神の既往がある患者に一過性に高度房室ブロックを認めた場合、ペースメーカー植え込みを考慮するが、その治療方針決定には個々で深慮する必要がある。症例は35歳男性、3度の失神の既往を持ち、動悸と嘔気を主訴に来院した。ホルター心電図で動悸を伴う心室性期外収縮と嘔気、おくび、味覚異常を伴う体位に依存しない5:4までの一過性高度房室ブロックを認めた。Head-up.tilt試験では血管抑制型の反応陽性で前失神状態を呈した。心臓電気生理検査で刺激伝導系に異常を認めず、房室ブロックは機能性ブロックと診断した。迷走神経系の関与を疑い、ペースメーカーの植え込みは行わず抗コリン作用を持つⅠ群不整脈薬ジソピラミドを300mg/日で投与すると、症状は軽快し心室性期外収縮と房室ブロックも消失した。5ヶ月後のホルター心電図で心室性期外収縮も房室ブロックも認めず、退院後20ヶ月間経過良好である。

Although high-degree atrioventricular (AV) block in patients with a history of syncope usually requires pacemaker implantation, therapeutic strategies should also be considered. A 35-year-old man presented with complaints of palpitations, nausea and dysgeusia. Since aged 30, the patient had experienced 3 episodes of syncope. Holter monitoring showed transient high-degree AV block (up to 5: 4 block) associated with nausea, eructation and dysgeusia irrelevant to posture as well as ventricular ectopic beats with palpitation. A Head-up tilt test revealed neurally-mediated vasodepression but electrophysiological study showed no abnormalities. These results indicated that his transient high-degree AV block was functional, and syncope would have been because of neurally-mediated vasodepression, not bradycardia. After administration of disopyramide at 300 mg daily, the symptoms subsided and ventricular ectopic beats and AV block disappeared. He has been well for 20 months.

Atrioventricular block

Syncope

Therapy

Medical sciences [ 490 ]

eng

日本心臓病学会

Elsevier Ireland Ltd

Copyright (c) 2008 Japanese College of Cardiology Published by Elsevier Ireland Ltd.

[ISSN] 0914-5087

[DOI] 10.1016/j.jjcc.2008.03.009

[NCID] AN10070473

[DOI] http://dx.doi.org/10.1016/j.jjcc.2008.03.009