80歳以上の高齢者心房細動の経過に関する検討

A Follow-up Study of the Elderly with Atrial Fibrillation(≧80 years or older)

要旨

　【目的】80歳以上の超高齢者心房細動の臨床経過を明らかにする．【方法】経食道心エコー施行時80～92歳(平均83.9歳)の心房細動23例を対象とした．全例死亡しており，心房細動発症から死亡までの経過を後ろ向きに検討した．追跡期間は1～64カ月(平均28.6カ月)である．【結果】死亡原因は塞栓症7例，心不全5例で，肺炎，悪性腫瘍などの心臓疾患以外が11例であった．塞栓症は脳塞栓5例，肺塞栓1例，全身塞栓1例であった．ワルファリン治療は10例に行われたが，そのうち4例で投与を中止する必要があった．原因は脳出血2例，便潜血1例，食道癌1例であった．脳塞栓症はワルファリン治療を受けた10例中1例であったが，ワルファリン治療を受けていない13例では5例に認められた．経食道心エコーでは左房内血栓を4例に認めた．全例ワルファリンを投与されたが，そのうち2例はワルファリン治療開始前にすでに脳塞栓を発症していた．【考察】ワルファリンは塞栓症を予防しうるが，副作用やその他の理由により投与中止を余儀なくされる場合も多く，高齢者ではワルファリン治療適応の判定に慎重を要する．

Summary

　This retrospective study was undertaken to evaluate the prognosis for elderly patients≧80 years of age with atrial fibrillation(af). The subjects consisted of 23 elderly patients 80～92 years of age (mean age, 83.9 years) who underwent transesophagial echocardiography (TEE). All of these patients are now dead. The duration of follow-up ranged from 1 month to 64 months, the average being 28.6 months. The causes of death were embolism 7, congestive heart failure 5, other diseases (pneumonia, malignancy, unknown) 11. Cerebral embolism occurred in 5 patients, lung and general embolism occured in 1. Ten patients were treated with warfarin. Four of these 10 patients required the discontinuation of warfarin. Two of these four suffered cerebral bleeding as an adverse reaction and another 2 patients suffered from stool occult blood and esophageal carcinoma. Although warfarin was administered, 1 of 10 patients developed cerebral embolism. In 5 of 13 patients who were not given warfarin, cerebral embolism occurred. TEE revealed the left atrial thrombus in 4 patients. Of all the patients treated with warfarine, 2 out of 4 patients had suffered cerebral embolism before warfarin administration. Although warfarin therapy is effective for prevention of embolism, our study showed there were some adverse reactions, requiring discontinuation and some ineffective cases. In elderly patients we must judge the indication for warfarin therapy carefully.