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A Case of Cardiac Sarcoidosis with Sustained Ventricular Tachycardia Originating from the Outflow Tract of the Right Ventricle Mitsuru Masaki 1 , Kenji Hamazaki 1 , Kazuma Iekusi 1 , Yoshihiko Araki 1 , Kouichi Higashimori 1 , Tomoyuki Hamaguchi 1 , Takatoshi Gotou 2 , Yoichiro Kasahara 2 , Shirou Kamakura 2 , Chikao Yutani 3 1Department of Cardiology, Osaka Prefectural Habikino Hospital 2Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center 3Department of Pathology, National Cardiovascular Center Keyword: 不整脈源性右室心筋症 , 心室頻拍 , サルコイドーシス , ARVC(arrhythmogenic right ventricular cardiomyopathy) , ventricular tachycardia , sarcoidosis pp.325-330
Published Date 2004/3/1
DOI https://doi.org/10.11477/mf.1404100278
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Summary

 A 33-year-old man was admitted to Osaka Prefectural Habikino Hospital because of palpitation sustained for 24 hours. He had had a pulmonary sarcoidosis for two years, confirmed by transbronchial lung biopsy. On admission this time, he had remained conscious and normotensive. The results of physical examination were unremarkable, except for sinus tachycardia(heart rate, 190 beats/min). An electrocardiograph showed wide QRS tachycardia, which returned to normal sinus rhythm under the treatment of intravenous injection of pilsicainide. Echocardiography revealed dyskinetic with dilatation of the right ventricle. In contrast, the left ventricle showed normal contraction. Coronary angiography was normal, and left ventriculography showed normokinesis. Thereafter, he repeatedly experienced ventricular tachycardia. He was transferred to the National Cardiovascular Center for evaluation by an electrophysiologic study, which revealed re-entrant sustained ventricular tachycardia originating from the outflow tract of the right ventricle. Catheter ablation was performed successfuly. A portion of the fibrosis with chronic inflammatory cell infiltration and epithelioid cell was deserved on the right ventricular endomyocardial biopsy. However granuloma with multinuclear giant cells was not detected. Neither gallium-67 nor 18F-fluoro-2-deoxyglucose positron emission tomography showed abnormal uptake in the myocardium. In this case, cardiac sarcoidosis of the right ventricle was suspected because of the patient's past history and findings of the right ventricular biopsy, magnetic resonance imaging, and electrophysiologic study.


Copyright © 2004, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1200 印刷版ISSN 0452-3458 医学書院

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