難治性てんかん患者の迷走神経刺激装置交換術中に高度房室ブロックを来した1症例

Complete Atrioventricular Block during Vagus Nerve Stimulator Replacement

要旨

　迷走神経刺激療法（vagus nerve stimulation：VNS）のジェネレータ交換術の周術期に高度房室ブロックを頻回に発症した症例を経験した。VNSでは周術期に重篤な徐脈性不整脈が発生することに注意が必要である。

　A 49-year-old female with a vagus nerve stimulator implanted 3 years earlier underwent surgery for the replacement of the pulse generator. During the surgery, the electrocardiogram showed a sudden complete atrioventricular block. The surgical procedure was immediately stopped, and cardiopulmonary resuscitation was performed；however, similar waveform abnormalities were seen repeatedly, and thus a temporary pacemaker lead was implanted. This patient’s case should be noted as a late complication of vagus nerve stimulation therapy, which may be influenced by anesthetic agents. The case also highlights the importance of preoperative evaluations. Clinicians should consider turning off a vagus nerve stimulator during anesthesia in some cases.