周産期に増悪し心不全を呈した発作性上室性頻拍症の1例

A Case of Tachycardia-induced Cardiomyopathy during Pregnancy

　32歳，女性．幼少時より短時間の動悸があったが放置していた．今回，妊娠30週にあたる1997年9月頃に動悸発作が持続，起坐呼吸も出現してきたため当院産科入院，内科併診となった．安静時心電図にて，四肢誘導低電位，V_1-4にてQS pattern，陰性T波を認め，頻拍発作時には心拍170〜200／分の発作性上室性頻拍を認めた．胸部X線写真上著明な心拡大，胸水，肺うっ血を認め，心臓超音波検査上，左室左房の拡大とびまん性の壁運動低下を認めた．発作性上室性頻拍の頻発による心機能低下が疑われたため，抗不整脈薬の投与，経静脈的ペーシングにより頻拍発作を減少させたところ早期に心不全の回復を認め，帝王切開にて無事出産した．その後，電気生理学的検査を施行，左室後中隔に副伝導路を確認，カテーテルアブレーションを行い，焼灼に成功した．以後発作も消失し，心機能も正常化した．

A 32-year-old female was admitted to our hospital with complaints of palpitation and orthopnea. Chest X-ray revealed bilateral pleural effusion, marked pulmo-nary congestion and cardiomegaly. ECG showed low voltage in limb leads, QS pattern and negative T in leads V_1-4, and narrow QRS tachycardia (HR170-200/ min) during palpitation attacks. Echocardiography revealed dilatation of the left atrium and the left ventri-cle. Wall motion of the left ventricle was diffusely hypokinetic. We tried verapamil and disopyramide, but episodes of supraventricular tachycardia persisted. The tachyarrhythmia was terminated by percutaneous trans-venous cardiac pacing, and cardiac function was im-proved. Caesarean section was performed without com-plications on the 6th day after admission. Electro-physiological study showed atrioventricular reentrant tachycardia, and catheter ablation to the left posterose-ptal accessory pathway was performed. After the abla-tion, the patients palpitaion was abolished and cardiac function was normalized. We diagnosed this case as tachycardia-induced cardiomyopathy.