臨床心臓電気生理 ... - me-times.co.jp

1 CRT . AV/PV delay . RVOT . RVOT RVOT.. AV/PV delay .. AV delay P latency .. CRT cardiac resynchronization . therapy AV delay . PQ . PQ . PQ PQ . 1 8 PQ .. AV delay PQ PQ 3 5 . PQ .. AV delay PQ . 40 50 ms AV/PV delay . PV . delay AV AV/PV delay . delay AV delay 1 3 . PV delay PQ . pacing rhythm 1. AV/PV. delay . AV delay AV delay refractory period . AV/PV delay V endless loop tachycardia AV/PV delay PVARP post ventricular atrial 2 short AV delay refractory period . 6, 7 . P AV delay PVARP .. AV delay PVARP total atrial refractory period . 3 AV delay 250ms . PVARP 250 ms 250 250 500ms . dyssynchrony .. AV/PV delay . A V. AV Delay PVARP. Total atrial refractory period P tracking .. AV Delay PVARP total atrial refractory period .. PQ PQ PQ PQ 3 AV delay . post ventricular atrial 1 PQ refractory period PVARP delay . PQ AV delay PVARP total atrial refractory period P . PQ . P . PQ .. a b c .. AV delay AV delay . 2 PQ a . PQ b PQ PQ . c PQ . 2 pacing rhythm total atrial refractory period AV/PV delay.

2 120/min 120/min AV/PV delay P . 2:1 PVARP Ritter AV delay endless loop tachycardia AV delay 2 AV delay AV/PV delay Doppler . AV delay 5a 8 . AV/PV delay . AV/PV delay .. QRS. ECG. AO. AV/PV delay Doppler TVI. AV/PV delay .. 4 TVI: time . velocity integral . time velocity integral . TVI Stroke volume 1 . AV/PV delay Stroke volume HR CO . AV/PV delay AV/PV delay TVI CO. 4 AV delay . TVI AV delay . Short AV Delay a b . AV Delay ECG. Heart Sound S1 S2 S1 ECG. Interruption of Doppler the Atrial Kick Heart Sound S1 S2 S1 .. VS-MVCSAVD : Interval between V Spike and the End of A Kick Doppler . short AV delay . Long AV Delay AV delay .. ECG AV Delay Heart Sound S1 S2 S1 AV delay AV Delay . Doppler VS-MVCLAVD : Interval between V Spike and the End of A Kick long AV delay . 5 a Ritter AV delay AV delay AV delay . Ritter AV delay . AV delay 2 AV delay AV delay .. Ritter's formula LAVD SAVD Vs-MVCSAVD Vs-MVCLAVD SAVD. LAVD; long AV delay, SAVD; short AV delay, Vs; ventricular spike, MVC; mitral valve closure.

3 B Ishikawa AV delay . AV delay . AV delay . AV delay . AV delay AV delay .. AV delay .. Ishikawa Method AV delay .. pacing rhythm 3. PQ . DDD 1 5 PQ . AV/PV delay . 7 . 6 . critical AV delay for the . appearance of diastolic mitral regurgitation AV/PV delay . 3 AV/PV delay .. AV/PV delay .. AV/PV delay . AV/PV delay . 4 AV/PV delay . A AV/PV delay .. AV/PV delay . Doppler . AV/PV delay 5 . 1 AV/PV delay . AV delay AV. delay . 6 66 . PQ 5b 5 .. 2 PQ . critical PQ interval PQ .. PQ . PQ .. a b .. ECG ECG. S1 S2 S1 S1 S2 S1.. 7 a .. PQ . b . QRS PQ . 4 pacing rhythm AV delay AV delay . PQ PQ AV delay . 11,12 . 200 300% 1 . 60% . AV delay . 9 . 8 AV delay .. quality of life . 9,10 . AV delay . critical AV AV delay . delay for the appearance of diastolic mitral AV delay . regurgitation . AV delay AV delay 2 . 10 AV delay . 11 . DDD R AV delay . VVIR. AV Synchrony . Cardiac Output VVI .. Exercise Level . 8 Exercise level Cardiac output . VVI . stroke volume DDD VVIR.

4 Fusion . stroke volume . AV synchrony DDD VVIR .. 9 . DDD VVIR . quality of life fusion fusion AV delay VV delay . Sinus rhythm AV delay 110 msec AV delay 80 msec 30ms 10 Atrioventricular AV delay 11 AV delay 110ms 30ms AV delay 110 30 80ms 80ms . pacing rhythm 5.. AV/PV delay 1 Ishikawa T, Kimura K, Nihei T, et al. Relationship PV delay basic pacing rate between diastolic mitral regurgitation and PQ interval or cardiac function in patients implanted with DDD.. pacemakers. PACE 1991; 14: 1797 1902. AV delay 2 Ishikawa T, Kimura K, Miyazaki N, et al. Diastolic mitral basic pacing rate regurgitation in patients with first degree atrioventricular block. PACE 1992; 15: 1927 1931. AV/PV delay 3 Ishikawa T, Sumita T, Kimura K, et al. Critical PQ. 200 ms 20 ms interval for the appearance of diastolic mitral regurgitation and optimal PQ interval in patients A . implanted with DDD pacemakers. PACE 1994; 17: 1989 . 1 1994. 4 Ishikawa T, Sumita T, Kimura K, et al.

5 Optimal atrioventricular delay setting and diastolic mitral regurgitation in patients implanted with DDD pacemaker. Eur J Cardiac pacing Electrophysiol 1996; 6: 23 27. 5 Ishikawa T, Sumita T, Kimura K, et al. Prediction of . optimal atrioventricular delay in patients implanted with DDD pacemakers. PACE 1999; 22: 1365 1371. AV/PV delay 6 Ishikawa T, Sumita S, Kimura K, et al. Efficacy of 200ms A atrioventricular sequential pacing and diastolic mitral regurgitation in patients with intrinsic atrioventricular AV/PV delay conduction. Jpn Circ J 2000; 64: 570 582.. 7 Hochleitner M, Hortangl H, Ng CK, et al. Usefulness of . physiological dual chamber pacing in drug-resistant AV/PV idopathic dilated cardiomyopathy. Am J Cardiol 1990; 66: delay PQ 1 198 202. 8 Ritter P, Dib JC, Mahaux V, et al. New method for 200 ms detecting the optimal atrioventricular delay in paced in PQ 50 ms DDD mode for complete atrio-ventricular block (abstract). PACE 1995; 18: 855.

6 9 Benditt DG, Milstein S, Buetikofer J, et al. Sensor- triggered, rate-variable cardiac pacing : Current AV/PV delay technologies and clinical implications. Ann Intern Med 1987; 107: 714 724. AV/PV delay 10 Lau CP, Wong C-K, Leung SK, et al. Superior cardiac Vs-MVC SAVD hemodynamics of atrioventricular synchrony over rate responsive pacing at submaximal exercise: Observation in AV/PV delay . activity sensing DDDR pacemakers. PACE 1990; 13: 5b 1832 1837. AV/PV delay 11 Ishikawa T, Sumita S, Kimura K, et al. Optimization of Follow-up atrioventricular delay and follow-up in a patient with congestive heart failure and with bi-ventricular pacing . Jpn Heart J 2001; 42: 781 787. 12 Noriko Inoue, Toshiyuki Ishikawa, Shinichi Sumita, AV/PV delay . Takeshi Nakagawa, Tsukasa Kobayashi, Kohei Matsushita, Katsumi Matsumoto, Yasuo Ohkusu, Minoru AV/PV delay Taima, Masami Kosuge, Kazuaki Uchino, Kazuo Kimura, Satoshi Umemura. Long-term follow-up of atrioventricular delay optimization in patients with biventricular pacing .

7 Circ J 2005; 69: 201 204.. 236 0004 3 9. TEL 045-787-2800 FAX 045-701-3738. 6 pacing rhythm RVOT.. Harry G. Mond, M. D. The Royal Melbourne Hospital, Australia . RVOT . RVOT . RVOT . 12 . RVOT .. 21 . 12 ECG . RVOT .. 12 RVOT .. 1,2 RVOT . 12 . 3,4 5 7 .. 7,8 9 .. 7Fr . RVOT .. 10 . 11 . 1 RVOT . 12,13 .. 4 11 .. 14 15 . 16 .. RVOT .. 17 20 .. RVOT 23,24 . RVOT . RVOT . RVOT . RVOT . 61 . pacing rhythm 7.. RVOT . 4 2 . focal .. RVOT . RVOT focus . focus RVOT . RVOT ECG .. 25 . 1 RVOT . 4 focus . 24 . 12 . RVOT 26,27 .. RVOT 22 . 21,24 . RVOT 2 . RVOT ECG . 1 . conus arteriosus RVOT .. QRS 21,28 32 . supraventricular crest .. septomarginal trabeculation . septoparietal trabeculations . RVOT . RVOT . RVOT RVOT . 33 35 29,30,32 . RVOT . Conus arteriosus . Supraventricular crest Septoparietal RVOT . trabeculations Anterior Septomarginal trabeculation Free Wall Anterior Moderator band Left Arm Sep RVOT Right Arm tu LV. Posterior m Aorta 1 RVOT.

8 Conus arteriosus . Posterior supraventricular crest . septoparietal trabeculation s 2 RVOT 4 . septomarginal trabeculation RVOT . LV Ao . 8 pacing rhythm RVOT RAO RVOT . CS great cardiac vein . 5 CS great cardiac vein PA RVOT . RVOT RAO . RVOT . lateral cardiac vein middle cardiac vein .. LAO 40 RVOT . 3 4 . 3 23 LAO 40 .. 3 . postero-anterior PA RVOT 4 LL Left Lateral 90 . 3 . RVOT .. 2 RVOT 1 1 . 100 6 . 4 .. 5 CS great cardiac vein . LAO 40 . PA 40 .. RAO 40 . PA . RAO LAO . 3 LAO 40 . PA 40 . RAO 40 . RVOT . RVOT . RVOT ECG .. PA RVOT . 4 LAO 40 . PA 40 . RAO 40 . RVO T 2 . PA RAO 6 LL . LAO 1 RVOT A . A 1 RVOT B .. pacing rhythm 9. RVOT 2 cm .. 2 Vlay 36,37 . 7 LAO LL .. 61 .. 25 . RVOT .. ECG 8 . QRS 21,29 31 . negative . 90 . QRS . positive . 21 2 .. RVOT .. 7 Fr . RVOT . 9 .. 8 RVOT . QS . R QRS.. F .. Posterior . 7 RVOT . PA RAO 40 . LL LAO 40 .. LL . LAO 9 2cm posterior . 10 pacing rhythm .. posterior 9 .. RAO 40 LAO .. posterior.

9 RVOT 100 . CS RVOT . RVOT . RVOT . anterior . RVOT . 1 4 11 . LL .. 8 . R negative .. 21 .. 12 . 10 .. 11 PA LAO 40 . RVOT . 10 PA posterior . RVOT . anterior . RVOT . pacing rhythm 11.. RVOT 500 RVOT . 3 RVOT . 37,38 .. RVOT . RVOT .. RVOT .. Medtronic Inc., .. 39 .. RVOT .. RVOT .. RVOT .. 100 RVOT . QRS .. 21 .. 21 .. Too High - No pacing Repositioned - threshold 12 PA RVOT . RVOT 10 V . RVOT . V . 12 pacing rhythm 7 Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman AR, Lee KL, Lamas GA, et a1. Adverse RVOT effect of ventricular pacing on heart failure and atrial posterior fibrillation among patients with normal baseline QRS. duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 2003; 107: 2932 . 2937. RVOT 8 Andersen HR, Thuesen L, Bagger JP, Vesterlund T, Thomsen PE. Prospective trial of atrial versus ventricular pacing in sick-sinus syndrome. Lancet 1994;. 344: 1523 1528.. 9 Andersen HR, Nielsen JC, Thomsen PE, Thuesen L, Mortensen PT, Vesterlund T, Pedersen AK.

10 Long-term follow-up of patients from a randomised trial of atrial versus ventricular pacing for sick-sinus syndrome. Lancet 1997; 350: 1210 1216.. 10 Prinzen FW, Augustijo CH, Arts T, Allessie MA, . Reneman RS. Redistribution of myocardial fiber strain Harry G. Mond, Richard J. Hillock, Irene H. and blood flow by asynchronous activation. Am J. Stevenson, Andrew D. McGavigan. The Right Physiol 1990; 259: H300 308. Ventricular Outflow Tract: The Road to Septal 11 Prinzen FW, Hunter WC, Wyman BT, McVeigh ER. pacing . PACE 2007; 30: 482 491. Mapping of regional myocardial strain and work during ventricular pacing : Experimental study using magnetic resonance imaging tagging. J Am Coll Cardiol 1999; 33: 1735 1742. 12 Giudici MC, Thornburg GA, Buck DL, Coyne EP, Walton MC, Paul DL, Sutton J. Comparison of right ventricular 1 Rosenqvist M, Isaaz K, Botvinick EH, Dae MW, Cockrell outflow tract and apical lead permanent pacing on J, Abbott JA, Schiller NB, et al.