心ペースメーカー植込みを行ったPickwick症候群の1例

A case of Pickwickian syndrome treated by implantation of a cardiac permanent pacemaker

　Pickwick症候群は，睡眠時無呼吸を伴い突然死を起こすことが知られている。その原因として，睡眠時無呼吸による著しい低酸素血症が上げられるが，無呼吸に伴う不整脈が突然死の原因と考えられる場合もある。今回われわれは，睡眠時無呼吸に重篤な徐脈性不整脈を伴ったPickwick症候群に対し，突然死の予防として心ペースメーカーの植込みを行ったので報告する。

A 41-year-old male was admitted to our hospital with congestive heart failure and bronchopneumo-nia. During hospitalization extreme sinus brady-cardia, sinus arrest up to 6. 2 seconds and high grade AV block were observed to occur simultaneously with apneic episodes of ECG monitoring. After that, a diagnosis of Pickwickian syndrome was made in this obese patient. In spite of weight reduction, change of sleep position and acetazolamide admini-stration, obstructive sleep apnea and severe bradyar-rhythmias were not improve.

These severe bradyarrhythmias and ventricular tachyarrhythmias may be one cause of the not in-frequent sudden deaths in patients with this Pick-wickian syndrome.

In addition to the tracheostomy, we propose that implantation of a cardiac permanent pacemaker should be selected for the bradyarrhythmias in association with the Pickwickian syndrome.