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S–ICD植込み4ヵ月後に心筋切除術を施行したところ完全左脚ブロックに変化したがS–ICDのセンシングに影響しなかったHOCMの1例
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JPY
Abstract
Transvenous implantable cardioverter defibrillator(TV–ICD) has several concerns about transvenous lead including mechanical complications in lead insertion, device related infection and lead malfunction. The incidence of lead related complications decrease using subcutaneous implantable cardioverter defibrillator (S–ICD). A 42–year –old male with hypertrophic cardiomyopathy(HCM) was admitted for shortness of breath. He was at high –risk of sudden cardiac death, whereas sinus and atrioventricular node function were preserved, and tachyarrhythmia necessitating anti –tachycardia pacing had not been recognized. His heart failure symptoms were refractory despite appropriate medical therapy. We sought to perform hybrid approach of S –ICD and surgical myectomy. The S–ICD had been implanted without a major trouble. Although hypertrophic myocardium had difficulty in screening of subcutaneous electrocardiogram, we successfully detected optimal sensing point at upper intercostals. He had complicated left bundle branch block following myectomy, however, sensing function of S –ICD was not impaired. S –ICD is an encouraging therapeutic option in patients with HCM.
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