4. 心外膜リードもしくは心内膜リードの選択

Transcription

1 人工臓器 最近の進歩 Daiji TAKEUCHI 1. はじめに 1 2. 小児科領域の患者の特徴 3. 小児ペースメーカの適応 ( 表 1) American College of Cardiology ACC /American Heart Association AHA / Heart Rhythm Society HRS ) 1) 3) 7 10 著者連絡先 ptakeuci@hij.twmu.ac.jp 4. 心外膜リードもしくは心内膜リードの選択 1) 体格 20 kg 3) 5) 15 kg 2) 血栓症 6),7) 表 1 1) 3) 1. AVB wide QRS bpm 70 bpm QT

2 表 ) 9),10) 3) 静脈閉塞 ) 13) 13) Cohen ) 4) 閾値, リードトラブルや reintervention 表 2 15) 17) 7) 18),19) Medtronics Bipolar Capture Epi St. Jude Medical Myodex 4.1 F active-fixation lead SelectSecure Lead System Medtronic selective-site pacing SelectSecure Lead System 8 F Select Site model C304S-59 cm C304L-69 cm Medtronic 4.1 F Select Site model C304S-59 cm C304L-69 cm Medtronic SelectSecure Lead System 5. 体格とペースメーカ本体のサイズ 4 5 kg Solus 2526T St. Jude MedicalSolus mm 6 mm 5.9 cm g 8 11 cm g single chamber pacing 6. ペーシング様式 dual chamber pacing DDD dual chamber pacing DDD bpm bpm

3 DDD 2 1 single chamber VVI-VVIR dysshynchrony 20),21) 1 1),22) 24) 24),25) 26),27) 28),29) 30) 7. 植え込み部位 31),32) 8. デバイス感染 33),34) 1 8 5),35),36) 2010 AHA 37) 9. リード抜去の問題 Cecchin radiofrequency-powered sheath 94 8 major 4 minor 4 38) 10. 遠隔モニタリング Medtronic CareLink Biotronik Home monitoring St. Jude Medical Merlin 39) 41) 11. その他 1)MRI 検査対応のペーシングデバイス MRI 2011 FDA MRI Revo MRI SureScan Pacing System Medtronic MRI CT MRI 2) ワイヤレスペーシング 42),43) 12. まとめ

4 Jour nal of Ar tificial Organs Cardiac pacing in pediatric patients: a review 文献 1) Epstein AE, DiMarco JP, Ellenbogen KA, et al: ACC/AHA/ HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/ AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiar rhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol 51: e1-62, ) Silka MJ, Bar-Cohen Y: Pacemakers and implantable cardioverter-defibrillators in pediatric patients. Heart Rhythm 3: , ) McLeod KA: Cardiac pacing in infants and children. Heart 96: , ) Stojanov PL, Savic DV, Zivkovic MB, et al: Permanent endovenous pediatric pacing: absence of lead failure--20 years follow-up study. 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5 cardiomyopathy following right ventricular pacing for AV block in young patients: resolution after upgrading to biventricular pacing systems. J Cardiovasc Electrophysiol 17: , ) Dodge-Khatami A, Kadner A, Dave H, et al: Left heart atrial and ventricular epicardial pacing through a left lateral thoracotomy in children: a safe approach with excellent functional and cosmetic results. Eur J Cardiothorac Surg 28: 541-5, ) Rausch CM, Hughes BH, Runciman M, et al: Axillary versus infraclavicular placement for endocardial heart rhythm devices in patients with pediatric and congenital heart disease. Am J Cardiol 106: , ) Silka MJ, Kron J, Dunnigan A, et al: Sudden cardiac death and the use of implantable cardioverter-defibrillators in pediatric patients. The Pediatric Electrophysiology Society. Circulation 87: 800-7, ) Klug D, Vaksmann G, Jar wé M, et al: Pacemaker lead infection in young patients. Pacing Clin Electrophysiol 26: , ) Silvetti MS, Drago F, Grutter G, et al: Twenty years of paediatric cardiac pacing: 515 pacemakers and 480 leads implanted in 292 patients. Europace 8: 530-6, ) Cohen MI, Bush DM, Gaynor JW, et al: Pediatric pacemaker infections: twenty years of experience. J Thorac Cardiovasc Surg 124: 821-7, ) Baddour LM, Epstein AE, Erickson CC, et al: Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation 121: , ) Cecchin F, Atallah J, Walsh EP, et al: Lead extraction in pediatric and congenital hear t disease patients. Circ Arrhythm Electrophysiol 3: , ) Jung W, Rillig A, Birkemeyer R, et al: Advances in remote monitoring of implantable pacemakers, cardiover ter defibrillators and cardiac resynchronization therapy systems. J Interv Card Electrophysiol 23: 73-85, ) Burri H, Senouf D. Remote monitoring and follow-up of pacemakers and implantable cardioverter defibrillators. Europace 11: 701-9, ) Hauck M, Bauer A, Voss F, et al: Home monitoring for early detection of implantable cardioverter-defibrillator failure: a single-center prospective observational study. Clin Res Cardiol 98: 19-24, ) Lee KL, Lau CP, Tse HF, et al: First human demonstration of cardiac stimulation with transcutaneous ultrasound energy deliver y: implications for wireless pacing with implantable devices. J Am Coll Cardiol 50: , ) Wieneke H, Konorza T, Erbel R, et al: Leadless pacing of the heart using induction technology: a feasibility study. Pacing Clin Electrophysiol 32: ,