579
ၡāāࢋ
ᙯᔣෟĈ͕ა ( Heart failure )
͕ГТՎ̼ڼᒚ ( Cardiac resynchronization therapy )
༼ޠጡ ( Pacemaker )
݈֏
ܕೀѐֽᐌᘽۏ͕̈́ጱგ̬ˢّڼᒚ۞ቿ ݎ൴णĂధк͕ঽଈ۞πӮх߿ѐ᛬ౌ̂̂
۞೩ĂֱঽଈࣧώΞਕЯࠎ͕ঽ൴҃εΝ ϠĂҭдனϤٺຬାآĂѣ࠹༊ּͧ۞ঽ ଈౌਕх߿˭ֽĂּтާّ͕҉ୟٕާّ͕҉
ۆĂҭߏĂᇹх߿˭ֽ۞ঽˠــ̙ߏܧ૱۞
ઉĂ͕Αਕᔘߏצז࠹༊۞ຫ๋Ăѩޢܮј ࠎ͕ა۞ঽଈĂͷ૱૱ЯѩซᗁੰĂ၆ঽ ଈăछल̈́ۤົౄјޝ̂۞ፉćϫ݈͕ა
۞ঽˠᇴϒుѐ˯̿Ă 2002 ѐ઼࡚͕םົ
ࢍĂБ࡚ࡗѣ̣Ѻ༱ˠଈѣ͕აĂՏѐࢋ܅
дཏঽଈ۞ᗁᒚྤ̂ࡗߏѺα˩ᆆ࡚
ܛĂͷ࣎ཏ۞ˠ˾ᇴϒͽՏѐ̣˩̣༱ˠ۞
ిޘдᆧΐĂҤࢍז 2037 ѐ࣎ᇴϫࡎ˘
˼༱ˠ ( http://www.nhlbi.nih.gov/resources/docs/
cht-book.htm )ĂЯѩ࣎યᗟ၁̙ट̈㌿Ą ņ͕ГТՎ̼ᒚڱŇ( cardiac resynchroniza- tion therapy, CRT ) ߏ੫၆ќᒺّ͕ა ( sys- tolic heart failure ) ়ଈ۞˘࣎ࡎّڼᒚĂᄃ็
۞˾ڇᘽۏٙᏜ۞ܐ৺ٕѨ৺֨ѣޝ̂۞म ҾĂιߏᖣϤۡତԼត͕ྯજ۞ሀёĂֽ྿ז ϲӈԼච͕Αਕ۞ϫ۞Ă˵ᖣϤχೋّೈ
ᒖĂᅳ͕ـр۞͞Шត̼ĂӈٙᏜ۞ͅШ
ݭ ( reverse remodeling )ćϤٺ CRT ༼ޠጡ˯ξ̙
זˬѐĂᓜԖྏរྵ͌ĂГΐ˯ᆊॾڀෳĂϫ݈
̙ გ ߏ ࡚ ΐ г ડ ٕ ߏ ለ ߷ ͕ ጯ ົ ౌ ၆ ତ צ C RT ۞ঽଈѣᚑॾ۞߄ᏴĂԧࣇ۞ઉܲԊϺѣ ᙷҬఢቑĂϫ݈ࢨט୧ІΒ߁Ĉ
˘ă৸ࡗ͕ጯົΑਕ̶ᙷ ( New York Heart Association Functional Class ) ௐˬƂα৺۞͕ა
˟ăν͕डத ( left ventricular ejection frac- tion, LVEF )̈ٺ 35 Ʀ
ˬă͕ဦពϯԆБّνՁڑܡᕝ ( com- plete left bundle branch block, cLBBB ) ͷ QRS ᆵ ޘ̂ٺ 130 ୮ࡋ
αăֹ̏ϡዋ༊۞ᘽۏଠט̪̙ਕԼච ϫ݈ C R T д઼̰ߏϡְ݈ᆶߤ۞͞ёგ טĂϤᗁरᄓะঽଈ۞࠹ᙯྤफ़೩ϦኛĂᆶ८
࿅ࡗฉĂ͘ఙޢĂυืՏˬז̱࣎͡Ϥ͕
ࡊᗁर੨ЪࢰگᑭߤĂෛঽˠېڶү፟ጡనؠ
۞አፋᄃᖸĄ
͕ГТՎ̼ڼᒚ ( CRT ) ۞៍هϤֽ
˘Ѩ͕۞ຨજ࠻ҬᖎಏĂҭ၁Βӣ˞ܧ
૱ኑᗔ۞ՎូĂ̚ঘ̈́ઉБ۞Ϡந็ጱր
( His-Purkinje system )ăϒቁ۞ࡪͅᑕăͽ̈́ϒ
૱۞҉҇ќᒺĂЇң˘࣎ᒖ༼ౌΞͽጱ͕
ᑒ۞Αਕள૱Ăͷצຫ۞ొЊ҉҇ົాԆ р۞ొЊĂ˳҃˳̝ፋ͕࣎ౌజٳćݭ۞
ּ̄тνՁڑ็ጱܡᕝٕдΠ͕ыٸ˞็͕ޠ አ༼ጡ۞ঽˠĂν͕ވ۞ঈੈֽཱིҋΠ͕ވ۞
҉҇Ă҃ܧϒ૱۞ His-Purkinje system Ăٺߏ༊
͕ވ̚ฟؕќᒺॡĂྵᅈ۞ጨ ( lateral free wall ) ᔘ՟ତќזќᒺܫཱིĂᔘઃд˯˘࣎න
ૺېၗĂඈזጨฟؕࢋќᒺॡĂ͕ވ̏̚གྷ ฟؕࢋනૺĂكѩಶညᙘᙘڕĂ̙ҭ͕ᑒ۞
ड़தҲĂͷᔘਈͧϒ૱͕Հк۞ਕณ̖ਕݍ
ૻჯҲᅮՐĄ
C RT ۞៍هಶߏֽҋٺ˯۞៍၅Ăтڍ ԧࣇጱໂ ( lead ) ٸཉдटٽؼᏵќᒺ۞ొ
ҜĂٕߏд͕ވЧٸཉ˘୧ጱቢĂТॡו
፬ăТॡќᒺĂߏ̙ߏಶΞͽឰ͕̙ТՎ۞ଐ ڶԼචĂซ҃Լត͕ა۞ঽĉ
ТՎ̼࣎៍ه၁̙֭ߏೀѐֽ̖Ꮈ
۞Ăѝд 1976 ѐ Forrester ඈˠдજۏ֗˯ࡁտ
݄ېજਔ়ঽॡಶ൴னĂߙ୧݄ېજਔܡ҃
ֹྍҕგֻٙᑕ۞͕҉ડાҕॡĂಶົౄј͕
ќᒺ̙ТՎ۞ଐԛĂ༊ॡϡ˞ dyssynchrony
࣎фֽԛट࣎ன෪
1Ăѐ ( 1977 ѐ ) ͟ώ۞
Miyazawau ᗁरдۓ۞͕˯ࡁտ͕ޠአ༼ጡጱ ໂו፬ొҜ၆͕۞ᇆᜩĂ൴னٸдΠ͕ы۞
ጱໂٸॡĂϤٺঈੈཱི۞็ጱ͞Шᄃϒ૱͕
̙ТĂ͕ќᒺ͞ڱ˵ᄃϒ૱ˠ̙ТĂ˵ಶౄ
јЧొҜќᒺ̙ТՎĂ҃༊ॡϡ۞ߏ a s y n - chrony ࣎ф
2ć࣎ф၁ܑ۞ߏТ˘࣎
ຍޥĂ۞ౌߏ͕Чડќᒺ̙ТՎ۞ଐԛĂ ᄃ̝ᄬຍ࠹ͅ۞ಶߏТՎّĂࡻ͛͛ᚥ̚Ξ֍
synchrony Ă ( re ) synchronization ۞ӈߏТՎ
̼Ă҃࣎៍هৌϒࠎˠٙࢦෛߏд 1990 ѐϐഇâ͞ࢬߏЯࠎν͕ވጱໂ۞னĂͷ జᑕϡдˠវ۞щБّ̈́ΞҖّజᙋ၁ĂΩ˘͞
ࢬ˵ߏЯࠎᇆညࡊԫ۞ซՎĂឰᗁरΞͽϡމ៍
۞͞ڱᑭߤ͕۞ТՎّ̝֭ณ̼Ăซ҃ࡁտ CRT ၆͕۞ᇆᜩĄ
CRT ༼ޠጡങˢ۞͞ڱ
ݭ۞ C RT ༼ޠጡΒ߁˘ښΞͽٸו
፬۞Ѱͽ̈́ˬ୧ጱໂĂѰ̂ొЊٸдᗆ˭
͞ࡗ ~ ˬ̶̳۞ϩ˭ҜཉĂˬ୧ጱໂགྷϤᗆ
˭ᐖਔٕᓖᐝᐖਔซˢ˯ටᐖਔГซˢ͕Ă
̚˘୧ጱໂཉٺΠ͕ٗĂΩ˘୧ጱໂཉٺΠ͕
ވĂ҃Г˘୧ጱໂགྷϤ݄ېᐖਔᚭ ( coronary sinus ) ซˢ̶Ҷдν͕ވγ۞ߙ୧͕ᐖਔ̶
ڑĂᖣϤጱໂბώ֗۞ѡޘĂጱໂΙдҕგ
̰ĂֱಶߏԆјݭ C R T ٙ౯۞ૄώՄ फ़Ą
˘ਠᄲֽĂ C RT ༼ޠጡ۞ങˢϫ݈ࢋϤ
͕̰ࡊᗁरд͕ጱგވ̰߉ҖĂፋ࣎࿅ࡗ
ืᇴ̈ॡĂঽଈʑਠତצԊొ౫ዕĂ֭дᗆ
˭͞ᄦౄ˘ϩ˭۞˾ఠĂޢˬ୧ጱໂ˘˘
ཉˢĂϤဦ˘Ξͽ࠻ν͕ވጱໂଂνᗆ˭
ᐖਔซˢೈᒖրޢᖼ˞ޝкᝈĂࠎ˞ឰጱໂ ซˢߙ୧͕ᐖਔ̶ڑϐბĂυืА̚۩۞
ጱ͔ᐘଭд݄ېᐖਔᚭ۞ฟ˾Ăϡਗ਼Ш۞ҕგ
ᛷᇆĂؠҜዋЪ۞ᐖਔ̶ڑĂᖣϡ˘ਠүགྷ
ϩ݄ېજਔፋԛఙ ( percutaneous coronary inter-
vention ) ۞ጱ͔ቢ ( wire ) ጱໂҌؠᕇĂϤٺ ᐖਔր۞តளّᅈͧજਔրࢋ̂۞ధкĂ ҕგ۞̈́֕ШــᙱͽീĂ૱૱ឰν͕
ވጱໂ۞ཉˢјࠎፋ࣎࿅̚߄ጼّ۞˘
ᒖĂˬ୧ጱໂౌཉٸрޢĂତ˯ѰĂ֭
Ѱཉˢϩ˭˾ఠ̚ಶ̂ΑӘјćѣॡĂ݄ېᐖ ਔրϤٺҕგ֕Ш͉࿅ٺᝈѡĂٕҕგටވ
࿅ٺ̈ĂֱଐڶౌΞਕֹᗁरٸୢଂᐖਔ րങˢν͕ވጱໂĂᖼϤ͕γࡊᗁरͽฟ
˥۞͞ёጱໂۡତؠдν͕ވ͕҉˯Ă҃
྿זТᇹ۞ड़ڍĂͷͽγࡊ۞͞ڱĂጱໂ۞Ҝ ཉ̙צࢨٺ݄ېᐖਔ۞̶οડાĂΞͽጱ ໂؠдЇңᓜԖ˯ᄮؠр۞ҜཉĂᕇߏ
๋˾ྵ̂Ăᔵܕѐֽ౹͘ఙ̏Ξͽֹϡ̰
ෛᙡֽซҖี͘ఙĂҭঽˠ̪ืБ֗౫ዕĄ
тңീณ͕۞ТՎ̼
ϫ݈Ξͽϡֽᑭរ͕ТՎّ۞̍ࢋߏ
ࢰگĂᔵ࿅Ν˵ѣˠྏϡι۞̍ᑭീ
͕۞ТՎّĂҭϤٺܮӀّᄃщБّ۞҂ณĂ
ֱ̍ϫ݈ౌઃдྏរล߱Ă՟ѣᒔᇃھ
۞ᑕϡć८ჃВॎᛷᇆ ( magnetic resonance imag- ing, MRI ) Ϥٺ၆హᖐѣྋژޘĂ၆͕҉
ᖐྻજ۞៍၅അѣ࠹༊۞ෞᆊĂҭϤٺ࣎
ᑭߤᄃ͕ޠአ༼ጡА͇˯۞̙࠹टĂֹ c a r - diac MRI ΪਕोֽᑭរإϏщ྅͕ޠአ༼ጡ۞ঽ ˠĂ࣎ࢨטֹ cardiac MRI տΪਕઃд જۏ၁រล߱҃ڱᇃھᓜԖᑕϡć८̄ᗁጯ۞
ᑭߤ ( radionuclide angioscintigraphy, RNA ) ˘ۡ
జ̳ᄮߏෞҤ͕Αਕ۞еਚĂ˵ѣˠྏ൴ण ϡ RNA ֽޘณ͕۞ТՎّĂҭϤٺͻܮӀ
ّĂᓜԖᑕϡ̪࠹༊ѣࢨć Myocardial con- trast echo ߏΩγ˘࣎അజ൴ण۞̍ĂᖣϤڦ ड˘дࢰگ˭ົពᇆ۞ᘽۏĂឰν͕ވ۞ට ވܪֽĂͽਬᄃ͕҉ડĂГͽཝహវ̶ژ Чొ͕҉۞ќᒺଐڶĂҭϤٺѩࢰگϡព ᇆפ̙ٽĂͷщБّ˵ѣޞซ˘ՎᗃĂ
ᑭߤϫ݈Ϊ֍ߐࡁտ
3Ą
Ҍٺࢰگд࣎ᅳા۞ᑕϡߏܧ૱ቿݎ
൴णĂ 1995 ѐᖐౌ˪ઙࢰگ ( color-coded tissue Doppler imaging, TDI ) ય͵Ă̜౪۞
Sogaard ඈˠࢵА೩ϡ TDI ֽܑன߉ͽ CRT ݈ ޢ͕ќᒺТՎّ۞ត̼
4Ăଂѩฟୁ˞Ϡந ጯछᄃࢰگछ̝ม۞ాඕĂࢰگᑒӄϠ நጯछ˞ྋ CRT ۞үϡ፟טăࢰگᑒӄᗁर ᎡᏴዋЪତצ CRT ۞ঽଈăࢰگ˵జϡֽү ࠎᖸঽଈăአፋ CRT ༼ޠጡనؠ۞ֶፂĄ TDI
̝ٙͽਕд࣎ᅳા၈ᜨᐝ֎Ă̂۞ࣧЯߏЯ ࠎιΞͽۡତณ̼͕҉҇۞ќᒺ˧Ă࠹ྵٺ็
ࢰگϡീณҕ߹ֽมତՐќᒺ˧۞͞ёĂ ѣޝ̂۞ซՎĂՀࢦࢋ۞ߏĂϤٺፖคߏॡมĂ ᓂคߏిޘĂ੨Ъ͕ဦ۞ᐂĂԧࣇΞͽͧྵ
̙Т͕҉ડќᒺ۞АޢĂଂ҃˞ྋ͕҉҇ќ ᒺ۞ېڶĂтѩᄲֽĂ TDI ߏӎಶΞͽүࠎീ
ณ͕ТՎ̼۞ᇾ҃ᇃھᑕϡ˞ĉְ၁˯Ă
ଂฟؕಶഅ೩זĂ͕۞ќᒺ̙֭ညԧࣇຐည
፟ୠёᑒ֤ᇹಏ৷Ă͕۞ԛې˵̙ߏᇾ۞
ፚԛٕΗԛĂٺߏЧёЧᇹ۞ീณᄃᇴፂᑕ
ྻ҃ϠĂ͕҉۞ᓂШќᒺ ( longitudinal contrac- tion ) ߏϫ݈૱జֹϡ˵ߏࡁտк۞ᇾĂ ҭ̂छ၆ٺࢋפᇹֱࣹડ֭ВᙊĂ Schuster ඈˠפ۞ߏ septal lateral basal segments
5Ă A n s a l o n e ඈˠפ۞ߏ 5 ࣎ basal segments
6Ă Turner ඈˠפ 6 ࣎ basal segments
7Ă Yu ඈˠ
8̈́ Bordachar ඈˠ
9ߏפ basal mid В 12 ࣎ seg- ments ĂҭೀͼౌΞ࠻ങˢ CRT ݈ޢ۞ត̼ć ፖШќᒺ˧ ( radial force ) ТՎّ۞ࢦࢋّ˵ѣˠ ࡁտĂϫ݈ግ۞ˠᔵྵ͌ĂҭϤѝഇࡁտព ϯĂፖШќᒺ˧ᄃ͕ވќᒺ˧ѣޝр۞ᙯᓑّĂ Dohi ඈˠ˵̝̏ϡдତצ CRT ۞ঽଈ֗˯ᑭ
ീĂזᄃᓂШќᒺ˘ᇹр۞៍၅ඕڍĂ Dohi
ֱ֭ᇴፂ၆ᗓ̶ĂՐ septum ̈́ lateral basal wall ಏҜડԛត ( strain ) ۞ॡมमĂͽΝ
ੵ͕҉̢࠹ٛԵ۞̒ᕘĂՀΞ࠻͕ТՎّ۞
ޘ
10ć҃Ă͕ߏ࣎តّ̼ޝ̂۞ጡءĂ
˘Ѩ۞͕ྯᄃ˭˘Ѩ۞͕ྯᔵ࠻Ҭ࠹ТĂҭְ
၁˯̏ѣֱ۞मâ̶ᛗീณ݈ጨă˭˘
̶ᛗീณޢጨĂᚑॾᄲֽ၁̏གྷ৭д̙Т۞
ϲ֖ᕇ˯Ăكѩ࠹ͧྵҋ̙̳πĂ˵ЯѩĂ
ܕ൴ण۞ 4D ϲវࢰگΞͽྋՙ࣎યᗟĂ ΞТॡࡔᐂ˘Ѩ͕ྯ̰ٙѣ͕ડ۞ྯજ
ྫĂΝੵЯീณ̙ТѨ͕ྯ͔۞ᄱम
11Ă Kuhl
ඈˠ֭ѩᄃ c a r d i a c M R I ࠹ͧྵ୮̙ᅊҒĂ Kenning ඈˠ
12ᄃ Kapetanakis ඈˠ
13˵̏дঽଈ
֗˯ᙋځι۞ΞҖّĄᓁ߁ֽᄲĂ CRT д͕
ა۞ঽଈ֗˯ٙणன۞ГТՎ̼۞ਕ˧̏གྷ
ҌႷĂ̙გϡࣹ͞ڱౌΞͽ࠻߉ͽ C RT
݈ޢ۞मҾĂͽѩࠎૄᖂĂ̂छၙၙ˞ྋזĂΞ ਕࣧώТՎ̼म҃ܧ LVEF म۞͕̖ߏ CRT ۞
̂צৈ۰Ą
͕ГТՎ̼ڼᒚ၆͕۞ᇆᜩ
CRT ၆ҕҖજ˧ጯ۞ᇆᜩ
C RT ၆͕Αਕ۞ᑒӄߏϲӈΞ֍۞Ăࡶ
ͽܬˢّ۞ Millar ጱგֽ៍ീঽଈ͕ވќᒺΑਕ ( +dP/dt
max)д߉ͽ CRT ݈ޢ۞मளĂΞ࠻ϲӈ
۞Լච
14Ă҃ᇹ۞Լචϫ݈̏གྷቁؠΞͽᜈ Ҍ͌Ηѐͽ˯
15Ăҭߏтڍͽࠎঽଈ͕̏གྷԼ චĂ҃CRT ᇶॡઃͤĂ͕Αਕົϲגតम
16Ă
༊ѣΞਕߏ͕ʑॡ̝มֽ̙̈́ᐺ۞ቡ߇Ă ҭፂҤࢍĂπӮᖸѐΗĂࡗѣˬ̶̝˘۞ঽଈ
ົЯЧёЧᇹ۞ࣧЯ҃ᇶॡ̚ᕝCRT
17ĂЯѩдᓜ Ԗ˯ቁ၁ߏ࣎ืࢋϒෛ۞યᗟĄ
C RT ၆ν͕डத̈́ဃಽᘝਗ਼߹۞ᇆᜩ˵
ߏ࠹༊ϒࢬ۞Ăдೀ࣎̂ݭ۞ᓜԖࡁտ ( MIRA- CLE, CARE-HF ) ౌΞ࠻זν͕ވडதᆧΐͽ
̈́ဃಽᘝਗ਼߹Լච۞ன෪
18-20Ăॡтڍ CRT ᇶઃĂν͕ވडதͽ̈́ဃಽᘝਗ਼߹˫ົГೋ
̼
8ćᔵ C RT ࢋ੫၆۞ߏν͕ވ۞ГТՎ
̼ĂҭΠ͕ވ۞Αਕ˵ົྫྷԼච
21,22ĂΪߏޝ ᙱᗃߏۡତᔘߏมତ۞ᙯܼĄ
ࣃ˘೩۞ߏĂֱΑਕ۞Լච֭՟ѣᆧΐ
͕҉۞ਈউณĂᄃങˢ CRT ݈࠹ͧĂдЃिې
ၗ˭ਈউณྵҲ
23Ă stress ଐڶ˭ਈউณ҃ͅྵ
23,24Ăܑ͕҉۞ड़த ( myocardial efficiency )
ᆧΐĂ҃צ˧ ( metabolic reserve ) Հр˞Ą CRT ၆͕Гݭ ( remodeling ) ۞ᇆᜩ
C RT Լච˞͕ќᒺ۞ТՎّĂᆧΐ˞͕
۞ќᒺΑਕĂܜഇ҃֏Ă͕ߏӎᒔ˞ॲώ
۞ԼតĉధкᓜԖࡁտౌᙋ၁ν͕ވනૺϐഇ̰
श ( left ventricular end-diastolic diameter, LVEDD )
̈́ν͕ވќᒺϐഇ̰श ( left ventricular end-sys- tolic diameter, LVESD ) ົഴ͌
8Ăд MIRACLE
trial ̚Ăᔘ࠻ז LV mass ˭ࢫ۞рன෪â˘
࣎ѣঽந̷ͯ៍၅۞ߏ D'Ascia ඈˠд͕ა ঽଈү۞̷ͯĂ൴ன߉ͽ CRT ̱࣎͡ޢĂ colla- gen volume fraction ă apoptotic index ̈́ TNF ɗ expression ౌ˭ࢫ˞
25ĂֱౌߏԼච͕Г
ݭ ( reverse remodeling ) ۞ᙋፂĄ CRT ၆ҋޠৠགྷր۞ᇆᜩ
ૄٺ၆͕აᘽۏ۞ࡁտĂԧࣇۢĂၙ
ّ͕ა۞ঽଈϹຏৠགྷૻޘܜഇ࿅Ă၆ঽ ଈ۞ޢѣ̙։۞ᇆᜩĂϹຏৠགྷ۞߿ّ၁֭
̙टٽീณĂΪਕͽ˘ֱมତ۞ᇴֽ˞ྋঽଈ វ̰Ϲຏৠགྷ̤ጬ۞ޘćѣତצ C R T ۞ঽ ଈĂ heart rate variability ົ˯چĂវ̰ cate- cholamine ፧ޘົ˭ࢫ
26Ă sympathetic nerve activ- ity ˵ົࢫҲ
27Ăᄃ֓ιצጡܡᕝ ( ɘ-blocker )
ٕҕგૺ˧৵ᖼೱ Ժט̈́ҕგૺ˧৵צጡ ܡᕝ ( angiotensin converting enzyme inhibitor/
angiotensin II receptor blocker ) ѣளѡТ̝̍ӻĄ
ι
CRT ˵၆ immune system
28Ă Cheyne-Stokes respiration
29ѣᇆᜩĂߏрߏᗼĉ፟טࠎң?ౌѣ ޞซ˘Վࡁտ˞ྋĄ
ᓜԖ̂ఢሀࡁտ ( Clinical trial )
CRT д˘ਠϒ૱ᚭٗඕ͕ޠ ( sinus rhythm ) ঽଈ
֗˯۞֎Ғ
ܕೀѐֽĂԸˢ C RT ࡁտ۞ᗁጯࠧˠ̀࠹
༊۞кĂՏѐ൴ܑд͛ᚥ˯۞ࡁտјڍ̙˭ᇴ ѺĂҭߏĂֱᙋፂΪਕពϯ CRT ၆͕ߏѣ р۞Ăҭֱ̙֭ߏۡତᙋፂᙋځ CRT ၆ঽ ଈ۞рĂЯѩԧࣇᅮࢋᗕ۠ᐌ፟۞ᓜԖྏរĂ
CRT ۡତᑕϡд͕ა۞ঽଈ֗˯Ăᖸ
ֱঽˠ۞ଐڶĂΐͽࢍͧྵĂᇹ̖ਕۢ
CRT ৌϒᓜԖ۞Αड़Ą
ྵѝ۞ೀѐĂϤٺќᐂ۞ঽˠᇴ̙ૉĂᖸ
۞ॡม̙ૉܜĂͧྵᙱ࠻ CRT ၆Ѫ˸த۞ᇆ ᜩĂֱྏរкΗͽ৸ࡗ͕ጯົΑਕ̶ᙷă̱
̶ᛗ֕ྮᗓീྏ ( 6-minute walking distance ) ̈́ Ϡ߿ݡኳયס ( quality of life, QOL ) ࠎᇾĂೀ
ͼٙѣ۞ᓜԖྏរౌពϯ CRT ΞͽԼචֱމ
៍۞ᇾ
6,19,30-34Ăֱ҃ᇾᐌ CRT ۞ઃͤү
ϡົГޘೋ̼
8ćҭৌϒଣז CRT Ξͽഴ͌Ѫ
˸தăؼܜх߿த۞Ăߏд 2003 ѐĂ Bradley ੫၆࿅Νೀѐ۞ࡁտٙү۞Ъ̶ّژ ( meta- analysis )Ă൴ன CRT ੵ˞ͽ˯۞Αड़γĂΞਕ၆
͕ЯّѪ˸̈́Гҝੰத˵ߏѣᑒѓ۞
35Ăٺߏд
ѐ۞ COMPANION
36,37̈́ CARE-HF
20̚Ăଣ
۞ ಶ ߏ ࣎ ࢦ ࢋ ۞ ᛉ ᗟ Ă ҃ ޝ Ꮈ ۞ ߏ Ă C RT ੵ˞ൺഇਕૉԼචঽˠাېγĂܜഇֽᄲ
˵ ቁ ၁ ਕ Լ ච Ѫ ˸ த Ă ഴ ͌ Г ҝ ੰ த Ă ҃ д CARE-HF ̚Ă Bentkover ඈˠ˵ͽѩྤफ़ଣј ώड़ৈ̶ژ ( cost-benefit )Ăᄮࠎᔵ CRT ᆊॾڀ
ෳĂҭ҂ᇋזЯࠎഴ͌ҝੰத̈́Ѫ˸தٙ༼࠷۞
Ă۰ߏम̙к۞
38Ą
CRT д͕ٗᝫજ ( Atrial fibrillation )ঽଈ֗˯۞֎Ғ
͕ა۞ঽˠϤٺ͕ވ̰ᑅ˧Ă૱มତ ጱ͕ٗᕖ͔͕̂҃ٗᝫજĂཏঽˠϤٺ՟
ѣᏱڱ͕͕ٗވТՎ̼ ( AV synchrony )Ă૱జލ
ੵдᓜԖྏរ̝γĂҭдன၁Ϡ߿྆Ă͕ა Ъ׀͕ٗᝫજ̙д͌ᇴĂϫ݈੫၆ᙷঽˠ۞ᓜ Ԗྏរౌពϯϒࢬ۞ड़ڍ
39-42ĂҭтТѝഇ۞ᓜ ԖྏរਠĂϫֱ݈ྏរౌΪଣז৸ࡗ͕ጯ
ົΑਕ̶ᙷă̶̱ᛗ֕ྮᗓീྏăͽ̈́Ϡ߿ݡ ኳયסĂΪѣ Hay ඈˠഅϡܬˢّ͞ёᐂҕҖ જ˧ጯ۞ត̼ ( +dP/dt )Ă҃ CRT ͧಏ˘
ጱໂו፬ ( ಏ˘ν͕ވו፬ٕಏϡΠ͕ވו፬ )
ֽр۞ඕኢ
43Ă Gaspaeini ඈˠᄮࠎĂᑕซ˘
Վ ͽ ፵ ۞ ͞ ё ౄ ј ٗ ވ ็ ጱ ܡ ᕝ Ă Ԇ Б ϡ C RT ֽଠטঽଈ۞͕ྯᇴ̈́็ጱ͞ШĂ̖ਕৌ
ϒԼචঽˠ۞ېڶ
44Ą
CRT д็͕༼ޠጡঽଈ֗˯۞֎Ғ
็͕ޠአ༼ጡ۞͕ވጱໂ˘ਠߏٸдΠ͕
ވ͕ыొĂ͕ޠአ༼ጡ۞͕ဦ࠻ֽಶޝ ညԆБνՁڑܡᕝĂ Bordachar ඈˠ
45៍၅ֱ֤
ֹϡ็͕ޠአ༼ጡͷѣ͕ა۞ঽଈ۞͕
ဦॡĂ൴னᔵࣇ۞͕ဦֹϡ༼ޠጡҭ
͕ა۞ঽଈ՟ѣमளĂ҃༊ࠎֱঽˠچ৺
ࠎ CRT ༼ޠጡॡĂቁ၁൴னঽଈ̙გдТՎ̼
ᇾ˯ă͕ќᒺ˧˯ͽ̈́ྻજਕ˧˯Ăౌז ځព۞ԼචĂͷԼච۞಼ޘᄃࣧώߏνՁڑ็ጱ ܡᕝ۞ঽଈ̙࠹˯˭
46ĂՀࠤ۰Ă Ritter ඈˠͧ
ྵࣧώΪѣᅅ͕Αਕצຫ۞ঽˠĂЯࠎ̙
Ъν͕ވќᒺΑਕ̈ٺ 3 5 % ۞୧ІĂЯѩତצ
็͕ޠአ༼ጡĂΩ˘ཏঽଈߏৌϒ͕ა ( ν͕ވќᒺΑਕ̈ٺ 3 5 % ) ͷνՁڑ็ጱܡ ᕝĂЯѩତצ CRT ڼᒚĂᖸ̱࣎͡ޢ൴ன֤
ֱࣧώ͕Αਕᔘр۞ঽଈЯ͕યᗟГˢੰ۞
፟தౣͧࣧώಶ͕ა۞ˠᔘ
47Ăֱ៍
၅Ωˠ̙༰ᘃႷĂߏӎ˭ѨГѣঽˠืࢋങˢ͕
ޠ አ ༼ ጡ ॡ Ă ԧ ࣇ ᑕ ྍ ˘ ฟ ؕ ಶ ࠎ ঽ ˠ ങ ˢ CRT? COMBAT trial ߏΩγ˘࣎ϒдซҖ̚۞̂
ݭ݈ᖀّࡁտĂЯ͕ຨ࿅ၙͷ͕ა۞ঽଈ
̶јĂ˘ତצ็͕ޠአ༼ጡڼᒚă˘
ۡତତצ CRT ڼᒚĂࢍᖸѐĂ៍၅ঽଈ х߿தĂ࣎ࡁտ۞ඕڍ๕υ၆Ϗֽ۞ᓜԖՙඉ
ౄјᇆᜩĂԧࣇΞͽϫͽޞ
48Ą
إѣۋᛉ۞ኝᗟ
CRT ၆͕ޠ̙ፋ۞ᇆᜩ
2003 ѐĂ Medina-Ravell ඈˠࢵޘ൴ܑ CRT
ົ͔Гໂ̼ ( repolarization ) ᗓ۞ଐԛ ( Β߁ QTc ă transmural dispersion of repolarization ඈ
ᇾ )Ă֭ീΞਕᆧΐ torsade des pointes ۞፟ົ
49Ă
̝ޢౙౙᜈᜈѣ˘ֱ९ּಡӘĂពϯ CRT ቁ၁ дߙֱঽଈ۞֗˯͔˞۞͕ޠ̙ፋ
50Ăଯ
ࣧЯĂѣΞਕߏϤٺ CRT ۞ LV lead Аו፬˞
epicardium Ă҃ϒ૱۞ Purkinje system ߏА߿
̼ endocardium ĂЯѩౄјΝໂ̼ᄃГໂ̼۞Լ តĂ҃Ăޢᜈ۞ࡁտݒѣ̶ڡ۞ඕڍĂѣֱࡁ տᄃ Medina-Ravell ѣᙷҬ۞ඕڍ
51ĂࠤҌΞͽү ࠎീ↢Ѫ۞ᇾ
5 2Ăѣֱඕڍݒᄃ̝ޫޫ࠹
ͅĂТᇹ۞Гໂ̼ᇾĂങˢ C R T ޢ҃ͅԼ
ච
53,54ćҌ͌זϫ݈ࠎͤĂԧࣇ࠻ז࣎ങˢݭ
͕Νᝫጡ ( implantable cardioverter defibrillator, ICD ) Ъ׀ֹϡ CRT ۞ᓜԖྏរඕڍĂ CRT ౌѣ ӄٺഴ͌ങˢݭ͕Νᝫጡٸ۞ѨᇴĂ˵ಶߏ ഴ͌˞ݭ͕ޠ̙ፋ൴Ϡ۞፟ົ
55,56Ăҭሕ дّ۞યᗟืያซ˘ՎࡁտᗃĄ
ν͕ވו፬ٕᗕ͕ވו፬ĉ
Ϥٺତצ C RT ۞ঽଈкᇴߏνՁڑ็ጱܡ ᕝĂܑϯঽଈ۞ΠՁڑ็ጱߏ՟ѣᅪᘣ۞ĂЯѩ
̙͌ˠૺĂᑕྍಏϡν͕ވו፬ಶрĂΠ͕ވ
۞Νໂ̼ያঽˠҋ̎۞ His-Purkinje system Ξਕ
ົͧΠ͕ы۞ጱໂו፬ֽՀрĂͽҕҖજ˧ጯ តֽ̼៍၅ϲӈّ۞ត̼Ăቁ၁тѩ
57Ă҃៍၅ ಏϡν͕ވו፬۞ঽˠĂྻજਕ˧̈́Ϡ߿ݡኳ˵
ౌѣځព۞Լච
58Ă̙࿅Ă༊ᄃᗕ͕ވו፬࠹ͧ
ྵॡĂݒ࠻̙ኡᐹኡК
59Ă҃ѣֱࡁտពϯ ң۰ྵᐹ˜Яˠ҃ள
60ćϤٺಏϡν͕ވו፬Ϊ
ֹϡ˘୧ጱໂĂ̙გдјώ˯ă͘ఙ۞ኑᗔޘ
˯ĂΪࢋν͕ވו፬̙ͧᗕ͕ވו፬मĂಏϡν
͕ވו፬ಶΞਕјࠎϏֽ۞ᔌ๕ć B-LEFT HF
61ͽ̈́ DECREASE-HF
62ߏ࣎ϒдซҖ̚۞ᓜԖ
ྏរĂϫ۞ӈдଣ࣎યᗟĂд̙˳۞ֽಶ
ົѣྋඍĄ ጱໂ۞Ҝཉ
ν͕ވጱໂ۞ཉٸҜཉ˵ߏ࣎ᇆᜩ C RT ड़ ਕ۞Я৵Ăтڍਕጱໂٸдќᒺ۞ડĂ நኢ˯ड़ڍᑕྍົрĂ҃Ϥٺќᒺ۞ડ
Яˠ҃ளĂٙͽዋ༊۞ҜཉᄃЪ˵༊Яˠ
҃ளćҭϤٺ͕ᐖਔ۞̶οѣࢨĂٕߏѣֱડ
ΞਕЯࠎញჯ̼ޘྵᚑࢦ҃ڱజ߿̼Ă
ֱଐڶౌົֹጱໂڱٸдࣧώᄮࠎநຐ۞
ҜཉĂ̂ᄲֽĂጨ݈ͧጨр
63Ă҃ޢጨᄃ
ጨम̙к
64Ą
Π͕ވጱໂ۞ཉٸҜཉ၆ C RT ۞ड़ਕҬͼ
˵ᑕྍѣᇆᜩĂѣˠΠ͕ы۞ጱໂொז͕ވ̚
ჽ ( right ventricular septum )Ă൴னᇹו፬۞
ड़ڍ͕ͧыֽ۞р
65Ăҭ van Campen ඈˠᄮࠎĂ
ٙᏜ۞ዋҜཉᑕྍߏЯˠ҃ள
66Ăϫ݈إϏѣ ВᙊĂ҃ᅮซ˘ՎࡁտֽᗃĄ
Ҍٺ͕ٗ۞ጱໂ˘ਠౌߏ̺дΠ͕ٗ҅ĂЯ ࠎ ᇹ ۞ ߛ ၹ ࠎ ᘦ ؠ Ă ҃ ன д ѣ ٙ Ꮬ ۞ screw-in ۞ጱໂĂŇᘦؠŇ̙ГߏཉٸጱໂҜཉ
˘۞҂ณĂѣˠ͕ٗ۞ጱໂᗆд͕ٗ̚
˯Ăຐឰν͕ٗᄃΠ͕ٗ۞ќᒺྵࠎТՎĂҭड़ ڍҬͼ̙֭тഇ
67Ą
͕͕ٗވؼᏵॡม ( AV delay ) ۞నؠ
χଂ 1999 ѐĂ Auricchio ඈˠ൴ன֭ٙ
ᏜŇዋ༊Ň۞͕͕ٗވؼᏵॡมĂ҃ߏЯˠ҃
ளޢ
57ĂЧёЧᇹ۞ࢍზᄃనؠ̳ё৾৾Ă ဦ˘Ĉঽଈങˢ CRT ༼ޠጡޢ۞ొ X ЍဦĄΞͽ࠻
֍Π͕ٗĞ ȋğăΠ͕ވĞ Ȍğăν͕ވ( C ) ጱ ໂĄ
ဦ˟Ĉঽଈങˢ CRT ༼ޠጡ݈ޢ۞͕ဦĄ CRT ݈Ă
͕ဦពϯԆБّνՁڑܡᕝć CRT ޢĂ͕
ဦពϯ QRS ត৫Ăͷ QRS คᖼШঽଈΠ˯͞Ą
̙ҭтѩĂ Verbeek ඈˠՀ೩ዋ༊۞͕͕ٗ
ވؼᏵॡมົצጱໂו፬Ҝཉ̙Т҃ѣमள
68Ă Հᆧΐనؠ۞ኑᗔّĂѣˠϡ߹གྷજਔ۞ҕ߹
ి-ॡม᎕ ( aortic velocity-time index, aortic VTI )
69ă ѣˠ៍၅߹གྷဃಽᘝҕ߹߹ి۞ᙷݭ ( mitral in- flow wave form )
70ăѣˠϡ߹གྷဃಽᘝ۞ҕ߹ి- ॡม᎕ ( mitral inflow velocity-time index, mitral in- flow VTI )
71ăѣˠϡ͕҉˧ณᇴ ( myocardial power index, MPI )
72Ăពϫ݈֭ВᙊĂ̙࿅
ॲፂ Jansen ඈˠϡܬˢّጱგീณ۞ඕڍĂҬͼ ဃಽᘝҕ߹۞ҕ߹ి-ॡม᎕ົͧજਔ۞ҕ߹
ి-ॡม᎕Հਕܑν͕ވ۞ +dP/dt
71Ăҭѩඕኢ
̪ืГរᙋĄ
ν͕ވᄃΠ͕ވؼᏵॡม ( VV delay ) ۞నؠ кᆧΐ˞ν͕ވጱໂ̝ޢĂΠ͕ވᄃν͕ވ ו፬۞ॡมึԔ˵ߏ࣎યᗟĂ CRT ࣣ˯ξॡĂ ν͕ވᄃΠ͕ވߏ˘ו፬۞ ( simultaneous pac- ing )ĂᇹҬͼ̖ЪТՎ̼۞ࣧĂҭߏ˘ֱ
̈ݭࡁտ൴னአፋν͕ވᄃΠ͕ވו፬۞ॡมम Ξͽͧ۰Тॡו፬ᆧΐՀк۞ν͕डதă͕
Ꮾᓁณăනૺഇ·ॡม ( diastolic filling time )ă Լච̙ТՎᇴ ( dyssynchrony index )
73-75ăࢫҲဃ ಽᘝਗ਼߹ᚑࢦޘĂᆧΐצᑅ˧ॡ۞ТՎّ
9,73,76ć
҃ͷዋ༊۞ν͕ވᄃΠ͕ވม˜Яˠ҃ளĂ צጱໂ۞ཉٸҜཉͽ̈́ঽˠώ֗۞ٗވඕېڶᇆ ᜩĂͷཉٸΗѐޢĂዋ༊۞ؼᏵॡมࣃΞਕົ
ѣត̼ĂᅮГአፋćϫ݈࣎ྵ̂ݭ੫၆࣎ᛉ ᗟ۞ᓜԖࡁտ۞ඕڍ၁ߏѣڡள۞Ă InSync III
ᖸঽˠ̱࣎͡۞ᓜԖাې̈́ྻજ˧Ăᄮࠎν͕
ވᄃΠ͕ވ۞ו፬ॡมᑕѣम ( sequential pacing )
ͧྵр
77Ăҭ RHYTHM II ݒᄮࠎ۰рᗼ֭
मள
78Ă༊ѣΞਕߏޢ۰۞ঽּᇴྵ͌ ( 422 v.s.121 )Ă࠻̙मளĂՀซ˘Վ۞̂ݭࡁտቁ ၁ѣυࢋّĂ DECREASE-HF trial ঽଈ̶ј ˬĂଣᗕ͕ވТॡו፬ăѣॡมАޢ۞ו
፬ͽ̈́ಏϡν͕ވו፬Ăᖸˬঽଈ۞ᓜԖ
াېͽ͕̈́វ᎕ត̼Ăԓ୕Ξͽྋՙтѩۋ ኢ̙Ѓ۞ྖᗟĂலౣĂአፋν͕ވᄃΠ͕ވؼ ᏵॡมमᅮࢋࢰگጯछᄃϠநጯछВТે
ҖĂтڍአ̙አፋ̙֭ᇆᜩЇңޢĂ˫ңυ кѩ˘ᓝĉ
ീֱࣹঽଈΞͽԼච ( responder )
ֱࣹˠᑕତצ C R T ڼᒚĉߏ࣎ܧ૱ࢦ
ࢋĂ˵ߏϫ݈ܧ૱ሤܝ۞ྖᗟâ͞ࢬ༊ߏЯ ࠎ CRT ಏᆊĂ҃Ω˘͞ࢬĂ၁˵ߏՀࢦࢋ
۞ࣧЯĂಶߏ̙֭ߏٙѣ۞ঽˠౌົצĂࠤҌ ѣ͌ొ̶۞ঽˠд߉ͽ CRT ޢĂᓜԖ˯҃ͅົ
ೋ̼Ăࠎ˞ͽ͌۞ᗁᒚྤആঽˠᏖפ̂۞
ӀĂԱֱ֤߉ͽ CRT ޢົѣԼච۞ঽˠព
ॾγࢦࢋĂӈٙᏜ۞ responder Ąᔵϫ݈੫ ၆ responder ۞ࡁտซҖ۞тͫтఊĂҭϤٺ̂
छֹٙϡ۞ responder ؠཌྷ൞ༀ႕ϫĂѣࢰگ
۞ត̼ăᓜԖাې۞Լචă˵ѣѪ˸த̈́Гҝੰ
த۞ഴ͌Ăጱϫ݈ᔵ̏གྷ̂ᄮؠ mechani- cal dyssynchrony ᄃ electrical dyssynchrony ̙ਕ˘
ໄ҃ኢ
79Ăࢰگ۞ mechanical dyssynchrony Ҭ ͼՀਕܑ͕̙ТՎ۞ଐԛĂ˵ՀਕᏰᙊྵ
Ξਕົצৈ۞ঽଈĂҭಶϫ݈ࠎͤĂ̪̙ਨ தԯڼᒚ྆ࢬ۞ QRS ᆵ̂ٺ 130 ୮ࡋԼј
ࢰگ˯۞̙ТՎᇴ ( dyssynchrony index )Ą
͕ဦܑ۞ߏ͕۞ঈੈཱིĂϤٺ็ጱ ᅪᘣͽҌٺ QRS duration ࿅ᆵĂຐ༊ႬĂྵ
זঈੈཱི۞͕ડ༊ົؼᏵќᒺĂ҃
࣎ໄهགྷ࿅ྏរᙋ၁
8 0˵˘ۡдᓜԖ˯ڻϡҌ
̫ĂϤᓜԖགྷរ۞៍၅ĂԧࣇۢĂಏϡ͕ဦ үࠎᇾ̙֭ૉ
81ĂٺߏΞᑭീ͕̙ТՎᇴ
۞ࢰگಶјࠎϫ݈ࡁտк۞̍ĄϤ݈ࢬଣ
CRT ၆͕ТՎّᇆᜩ۞߱རĂ۰ಶΞͽ
˞ྋĂΞֹϡ۞ᇾ࠹༊кĂ Yu ඈˠд 2004 ѐ
18 Ϥ็ࢰگ̈́ᖐౌ˪ઙࢰگז
۞ᇾोֽઇͧྵĂ࠻࠻ࣹ࣎ᇾਕീν͕
ވ ड த ͽ ̈́ ν ͕ ވ Г ݭ ۞ Լ ච Ă ඕ ڍ Ϥ 2003 ѐ Yu ҋ౹۞ᇾ౼ ( 12 ࣎ડ electrome- chanical delay ۞ᇾम )
82ĂҭϤٺν͕ވडத
۞Լචٕߏν͕ވГݭ ( remodeling ) ۞ត̼ல
ౣ̙ਕԆБܑঽˠৌϒ۞ᓜԖېڶĂซҖ̚۞
PROSPECT trial ᖸ۞ᇾԼࠎঽˠᓜԖাې ᄃྻજ˧Ăԓ୕Ξͽྋՙ࣎རम
83Ą
ੵ˞ࢰگγĂ۞ᇆညԫఙ˵അϡֽྏ
រ၆ٺ responder ۞ീّĂΒ߁ϒ̄ٸडཝ
ᕝᆸବೡ ( positron emission tomography, PET ) ࠻
Π͕ވٕν͕ވ۞ᔁăಏЍ̄ٸडཝᕝᆸବ
ೡ ( Single-photon emission computed tomography, SPECT )࠻͕҉߹ޘă၆ّ͕ͧࢰگ( my- ocardial contrast echo ) ࠻͕҉۞߿ّ ( viability )Ăࠤ Ҍѣˠ൴ځགྷࢴٕགྷጱგᇶॡّጱໂĂֽۡତ
៍ീঽଈ۞͕ΑਕߏӎົѣԼචГֽՙؠࢋ̙
ࢋങˢ CRT ༼ޠጡĂֱౌᔘдࡁտล߱Ă̙
࿅Ϥϒ̄ٸडཝᕝᆸବೡ̈́၆ّ͕ͧࢰگ
۞ࡁտĂԧࣇΞͽፑྋĂᚑࢦ݄ېજਔ়ঽ͔ٙ
۞͕აĂֽ࿆ᄲĂ၆ CRT ۞ͅᑕͧྵ
मĂ҃ᖣϤֱଣീ͕҉х߿ޘ۞̍ĂٕధΞ ͽԼචཏঽଈ၆ CRT ۞ड़ڍĄ
CRT дܧνՁڑܡᕝঽଈ֗˯۞֎Ғ
Egoavil ඈˠፋந MIRACLE ̈́ Contak CD t r i a l ྆ΠՁڑԆБܡᕝ۞ঽˠĂ̙გߏᓜԖা
ېăྻજ˧ă͕ќᒺ˧ăϹຏৠགྷ߿ّĂҬͼ
ౌ՟ѣ̦ᆃԼච
84ć҃ Garrigue ඈˠᄮࠎтڍ
͕̈߄ᏴঽଈĂࢰگ˯ӔனТՎ̼ᇴम۞ঽ ˠᔘߏΞਕѣᑒӄ
85Ą
݈ࢬഅགྷ೩࿅Ă͕ဦ՟ѣᏱڱԆБܑன͕
ќᒺ۞̙ТՎĂٙͽ QRS ᆵ۞ঽˠ̪ѣΞਕ ѣإр۞ТՎّĂ҃јࠎٙᏜ۞ n o n - r e s p o n - der ć̝ͅĂ͕ဦϒ૱۞ঽˠѣΞਕ̙ТՎ
۞ଐڶ࠹༊ᚑࢦĂ Turner ඈˠྏд͕ဦ࠻Ҭ ϒ૱ҭࢰگពϯ̙ТՎଐڶᚑࢦ۞͕აঽ ଈങˢ CRT Ăͽങˢޢ۞ТՎّᇾֽ࠻Ҭѣ ซՎ
7ĂҭৌϒᓜԖېڶ۞ᖸྤफ़ݒߏଂĂ ЯѩĂ CRT ၆ٺ QRS ᆵޘϒ૱ҭ͕აঽଈ
۞֎ҒĂ̪ѣޞซ˘ՎࡁտᗃĄ
CRT ۞ܢΐΑਕ
C RT ༼ޠጡϫ݈ѣ˘࣎̏ࡁ൴ҭ̪Ϗགྷ̂
ఢሀࡁտ۞ΑਕĂჍүටܡႾീᆇ ( i n - trathoracic impedance monitoring )ĂᖣϤᖸ၏
̰۞ܡֽଯᕝঽˠ۱̰᎕ͪ۞ଐԛĂ̈́ѝග̟
ঽଈ೩ᏹĂԓ୕ਕ྿ז̈́ѝཉͽഴ͌ҝੰ፟த
۞ड़ڍ
86Ăϫ݈࣎Αਕ၆ٺᓜԖ᜕۞ᑒӄᔘ ѣޞ៍၅Ăୂຏޘ̈́ቁّ˵ѣޞԼซĂҭҬͼ ߏ࣎ޝр۞ࡎĂԧࣇΞͽഇ୕ιϏֽ۞൴णĄ
ඕኢ
C RT ߏ͕აڼᒚ̚ܧᘽۏ۞ڼᒚ͞ڱ
̝˘Ăι۞Αड़̏གྷдధк۞ᓜԖྏរ̚జᙋ ၁Ă҃ι۞ᓜԖᑕϡ˵ు͟дᆧΐ̚Ăҭָ۞
ТՎ̼ᇾזغࠎңĉтңീ r e s p o n d e r ĉ C RT ώ֗۞నؠăጱໂཉٸ۞ҜཉĂߏӎѣ
р۞ᇾĉߏӎᑕᕖ̂ CRT ۞ዋᑕাүࠎ̈́ѝ
֨۞ඉரĉͽ̈́ٙࢉϠ۞࠹ᙯགྷᑻયᗟඈ ඈĂౌѣޞՀк࠹ᙯˠࣶ۞ԸˢĂ̖ਕ၆ C RT ѣՀၔ۞˞ྋĄ
ણ҂͛ᚥ
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A New Device Therapy for Heart Failure Treatment --- Cardiac Resynchronization Therapy
Chih-Chieh Yu, Jiunn-Lee Lin
1, and Ling-Ping Lai
Congestive heart failure is a major burden in modern society. Cardiac resynchronization therapy (CRT) im- proves cardiac function by allowing the ventricle to contract in a synchronized mode. By breaking the vicious cy- cle of heart failure, CRT reverses cardiac remodeling and therefore increases heart contractility. Not only does CRT improve the symptoms of heart failure, but it also prolongs the survival of heart failure patients, as shown in clinical trials. All physicians, including primary care physicians, should know this new therapeutic option and be familiar with the related issues. ( J Intern Med Taiwan 2008; 19: 103- 114 )
Department of Internal Medicine,
National Taiwan University Hospital, Yun-Lin Branch;
1
