洞不全症候群と高度房室ブロック患者の症状と予後に対するペースメーカー植え込みの影響

Effects of pacemaker implantation on prognosis and symptoms in patient with sick sinus syndrome and advanced AV block

　徐脈性心疾患の治療にペースメーカーの果す役割は非常に大きいが，ペースメーカー植込みが長期予後にどう影響するかについてはなお問題点が残されている。多くの報告ではペースメーカーは徐脈性心疾患々者にとり，最良の治療法と結論しているが^1〜4），Wohlらは洞不全症候群ではペースメーカー植込み後も死亡率が高く，予後は不良であると報告している^5）。またペースメーカー移植後に患者の自覚症状，および身体活動能力がどの程度改善しているかについての報告は少ない。

　ここでは徐脈性心疾患々者の追跡調査をおこない，ペースメーカー植込みの有無による予後と個々の症状の推移を検討した。

To investigate the effects of long-term pacing on symptoms and prognosis, 58 patients with sick sinus syndrome (SSS) and 39 with advanced AV block (AVB) were followed for 6 to 180 months (average : 35 months). Eighteen cases with SSS and 5 with AVB were unavailable for follow-up. Of the 74 patients followed, 20 with SSS and 28 with AVB were implanted with ventricular pacemaker.

Clinical symptoms and physical activity were improved in 10 cases and were unchanged or worsened in 5 out of the 20 paced patients with SSS, and the remaining 5 died. Among the 20 patients with SSS who were followed without pacemaker implantation, 11 improved, 7 were unchanged or worsened, and 2 died. Syncope in the patients with SSS was almost abolished with the use of permanent pacemaker, but other symptoms such as dizziness, dyspnea and chest pain were remained unchanged in both of paced and not paced SSS patients.