心電図上異常Q波の認められたArrhythmogenic right ventricular dysplasiaの1例

A case of arrhythmogenic right ventricular dysplasia with abnormal Q waves in ECG

　Arrhythmogenic right ventricular dysplasia （以下ARVD）は1978年Fontaineら^1）によって提唱された症候群であるが，本邦でも近年報告が成され決して少なくないことが注目されている。しかしその成因・他の心筋症との関連について不明な点も多く，議論を呼んでいる。最近我々は心電図上後側壁梗塞を思わせるARVDと考えられる1症例を経験したので報告する。

A 39-year-old man was admitted to our hospital because of a syncopal attack in March 1986. Patient first experienced a syncopal attack in 1970. Clinical diagnosis of ventricular tachycardia was confirmed by ECG obtained at the second syncopal attack in 1975. An ECG during sinus rhythm in 1975 showed deep Q waves and poor R wave progression in lead Ⅰ, V₅, V₆, inverted T waves in V₁ to V₄ and notching on ST segment. The VT had a rate 200/min and QRS complexes showed a left bundle branch block pattern with left axis deviation. On admission, ECG revealed multifocal premature ventricular beats, R/S>1 in V₁, deeper Q waves and poorer R wave progression lead Ⅰ, V₅, V₆ than in 1975. A right ventriculogram revealed dilatation of the right ven-tricle with a marked reduction in its contraction. (EF 23%) A left ventricular contraction mildly re-duced at posterolateral wall motion (EF 53%) and the coronary arteries were normal. Diagnosis of ARVD was considered.

Cardiomyopathic ECGs often show abnormal Q waves. But cases of ARVD with abnormal Q waves in ECG are rare. This case suggests that ARVD is a myopathy which affects not only the right but also the left ventricular wall.