徐脈性不整脈を呈する心筋症のペースメーカー植え込み例の検討

Clinical study on the case with cardiomyopathy treated with artificial cardiac pacemaker

　心筋症は，その殆んどが進行性で各種の治療に抵抗を示し，致命的な疾患であるということは周知の通りである。心筋症の病態は肥大型，拡張型に大別され，それらの血行動態，病態に学問的興味の中心がおかれてきたが，一方において突然死の原因となる不整脈も本症の一つの大きな問題であると言わなければならない。私共はこれまで心筋症を基礎疾患に有する徐脈性不整脈の治療として35例の永久植え込み型ペースメーカー（PM）の植え込み術を経験している。そこで，これら症例の臨床事項及び予後に関し検討を加えてみたのでここにその結果の一端を報告する。

The authors experienced the implantation of artificial cardiac pacemaker (PM) in 550 cases with symptomatic bradyarrhythmia between 1974 and 1983, and 35 cases among them (6.4%) were considered having cardiomyopathy as underlying disease. 13 cases were classified as hypertrophic cardiomyopathy (HCM) and 22 cases as dilated cardiomyopathy (DCM).

Preoperative electrocardiographic finding was A-V block in 54%, sick sinus syndrome III in 31% of HCM, and atrial fibrillation with slow heart beat in 55%, A-V block in 18% of DCM.

Preoperative main sign and symptom was Adams-Stokes attack in HCM and heart failure in DCM, and the suffering duration before PM implantation was longer in HCM than in DCM.

Early postoperative improvement was exellent especially in DCM, while late postoperative death was found by 15% in HCM and by 41% in DCM.

In conclusion, PM implantation should be con-sidered to be the choice of treatment of cardiomyo-pathy with symptomatic bradyarrhythmia, since symptom and sign due to bradyarrhythmia were improved remarkablly during the early postopera-tive course, and careful management should be tak-en after PM implantation.