根治的治療を要した薬剤抵抗性心室頻拍例の検討

Aggressive therapy for ventricular tachycardia refractory to medical treatment

　心拍数の速い持続性心室頻拍（sustained VT）は、血圧低下や失神等重篤な症状をきたし，時に突然死をもたらすため^1）その予防は必須である。近年，電気生理学的検査（electrophysiologic study：EPS）によるVTの機序の解析^2），薬剤の信頼できる効果判定^3）が可能となった。またEPSによりVTのfocusの決定が可能となり，薬剤抵抗性と判定されたVTに対し外科的治療^4）やelectrical ablation^5,6）などの積極的かつ根治的治療も可能となった。今回我々は，薬剤抵抗性と判定され，根治的治療が必要とされたVT例について検討し報告する。

Nine patients with ventricular tachycardia (VT) refractory to medical therapy underwent aggressive therapy. Eight patients were surgically treated and one patient by electrical ablation. There were 6 men and 3 women. The age ranged from 28 to 72 years. Two patients had a previous myocardial infarction with LV aneuyrysm (LV An), 2 patients had LVAn with normal coronary arteries. Two patients had RV dysplasia. Two patients were in post operativestate for tetralogy of Fallot (T/F), and 1 patient had a cardiac fibroma. All patients underwent electrophysiological study (EPS) including catheter endocardial mapping. Intraoperative mapping studies confirmed the preoperative studies in 8 patients. Seven patients underwent endocardial resection and cryosurgery. Cardiac fibroma was removed in one. VT was cured in 8 among 9 cases, remaining 1 patient had a recurrence of VT with different QRS configuration. In one patient, electrical ablation was done. Six months later, VT with different QRS confi-guration appeared and electrical ablation was repe-ated. VT became not inducible even after a use of isoproterenol. Aggressive therapy for medically intr-actable VT could be cured with high success rate if they were guided by EPS.