ペースメーカのホルター機能が不整脈の診断・治療に有効であった2例

Usefuhness of a VDD Pacemaker Holter Function for the Diagnosis and Treatment of Arrhythmias

　VDDモードペースメーカの植込み後に，ペースメーカに内蔵されたホルター機能により，慢性期経過中に発生した不整脈の診断と治療が有効に行われた症例を報告する．

　症例1：69歳，女性．拡張型心筋症にて通院中，発作性心房細動と完全房室ブロックを認め，VDDモードペースメーカ植込み術を施行した．植込み8カ月後に動悸，嘔吐，冷汗，意識混濁を来して来院し，この時心拍数200／分のwide QRS頻拍を認めた．ペースメーカ内蔵のホルター機能（レートヒストグラム）にて房室解離を認め，心室頻拍と診断し，アミオダロン投与にて改善した．

　症例2：77歳，男性．完全房室ブロックにてVDDモードペースメーカ植込み術を施行した．定期的なペースメーカクリニックにおいて，ペースメーカ内蔵のホルター記録でモードスイッチ作動していることを認め，これより発作性心房細動の発生を診断した．以後メチルジゴキシンの投与を開始し，発作性心房細動の再発を認めなかった．

　ペースメーカ内蔵のホルター機能は，ペースメーカ植込み後の不整脈の診断および治療効果の評価に有効であった．

Recently cardiac pacemakers with Holter function have been developed in order to help the management of pacemaker implanted patients.

We reported 2 patients, whose arrhythmias were able to be diagnosed with the Holter function of a VDD pacemaker long after the implantation of their pace-makers.

Case 1. A 69-year-old woman with dilated car-diomyopathy was implanted with a VDD pacemaker because of complete atrio-ventricular block.

She suffered from palpitation, vomitting, cold sweat and loss of consciousness eight months after the im-plantation of pacemaker. Her ECG showed wide QRS tachycardia of heart rate, 200/min. Atrioventricular dissociation was found from the pacemaker Holter record, and the arrhythmia was diagnosed as ventricular tachycardia. After administration of amiodarone, she recovered and her recovery has been maintained.

Case 2. A 77-year-old man was implanted with a VDD pacemaker because of complete atrio-ventricular block. On the occasion of a regular check-up at a pacemaker clinic, paroxysmal atrial fibrillation was found from episodes in the pacemaker Holter record. After adminis-tration of digoxin. he recovered and his recovery has been maintained.

In these cases, the pacemaker Holter function was useful for the diagnosis and treatment of arrhythmias of patients implanted with cardiac pacemakers.