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Closed– loop stimulation(CLS)が心拍応答に著効した洞不全症候群の1例
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JPY
Abstract
The rate response system in cardiac pacemakers is ef ficacious for exercise performances in patients with chronotropic incompetence who depends on cardiac pacing. The closed–loop stimulation(CLS) is a novel rate response system which measures alterations in intra–cardiac impedance regulated by myocardial contractility. We report a case who obtained an appropriate rate response by changing the rate response system to CLS from accelerometers. An 82 years–old male was admitted to our hospital with acute heart failure due to sick sinus syndrome with atrial flutter/fibrillation. He underwent DDD pacemaker implantation(Evia DR–T, BiotronikTM). The rate response system was added with an accelerometer sensor. Five years later, an additional RV lead was implanted because of a lead failure of the former RV lead, and the generator was replaced(Epyra 8 DR–T, BiotronikTM). Afterwards, he complained of dyspnea on effort. His heart rate histogram demonstrated a complete dependence on atrial pacing and a lack of rate response, while there were no changes in serum NT–proBNP levels or cardio –thoracic ratios in chest X–ray. We considered that the disappearance of rate response might be responsible for his symptoms, and changed the rate response system to CLS. As a result, his heart rate became sensitive to daily activities, and the symptoms almost disappeared. In conclusion, although accelerometers have been widely used for the rate response system, they can be affected by the position or direction of generators, and may not always provide appropriate responses to body movement. CLS is an alternative tool for optimal rate response when other systems did not work properly.
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