右脚ブロックパターンを呈した経静脈心内膜下ペーシング患者の一剖検例

An autopsy case report:Right bundle branch block during transvenous ventricular pacing

　経静脈右室ペーシング時の心電図パターンは，普通には左脚ブロック（LBBB）型を呈することが知られており，右脚ブロック（RBBB）型を示すときにはカテ先の（i）冠静脈洞への挿入，（ii）左室側への穿孔，（iii）位置異常などの合併症が起ったと考えなければならない1〜4）。

　我々は経静脈右室ペーシングでRBBB型を呈し，剖検にて右室心内膜下に電極の先端が固定されていることを確認しえた症例を経験したので若干の文献的考察を加え検討する。

Pervenous right ventricular pacing usually showed a pattern of left bundle branch block (LBBB). When a right bundle branch block (RBBB) pattern is appeared during right ven-tricular pacing, complications such as perforation of the ventricular septum or malposition of the catheter should be suspected.

A 91 year-old woman revealed a RBBB pattern during the right ventricular transvenous pacing. The current patient experienced a " Stokes-Adams" attack at 88 year old (February, 1975), when the ECG showed a second degree of sino-atrial block.This patient was diagnosed as having "sick sinus syndrome" by the analysis of His bundle elec-trocardiogram. Consequently, a permanent endo-cardial pacemaker of demand type was inplanted. The 12-lead ECG showed a RBBB pattern, but no clinical evidence of perforation of the catheter into the left ventricle was observed. Two years later, the pacemaker generator was replaced, be-cause of the battery failure. Thereafter her general condition was gradually deteriorated and finally she was expired on September 1977.