[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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A 60-year-old female who was diagnosed with cardiac sarcoidosis admitted to our hospital because of recurrent ventricular tachycardia (VT). Echocardiography showed thinning of the basal interventricular septum and ejection fraction of 26%. Left ventriculography revealed a ventricular aneurysm involving the anterior region, apex and septal segment despite normal coronary arteries. CARTO voltage mapping of both ventricles showed a low voltage area (LVA) only in the basal interventricular septum. Moreover, there were 4 scar points where maximum output pacing could not be captured in the LVA of the basal anteroseptal right ventricle. A VT (left bundle branch block pattern and superior axis) with a cycle length (CL) of 440 ms was induced by a single right ventricular extrastimulus. Delayed potentials were recorded from a His bundle electrode during sinus rhythm, and further more, mid-diastolic potential (MDP) was recorded during the VT. An isochronal map displayed a figure-8 reentry between the right septal scars. A phenomenon of VT termination without global capture was observed during entrainment pacing at the center of the LVA, where the MDP was recorded. At that site, VT was terminated by a single radiofrequency energy application. The VT became non-inducible after creating a linear ablation between the scars. This is the first case in which this rare phenomenon has been recorded in a patient with cardiac sarcoidosis.

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We present herein three cases with complications which required psychosomatic approaches during device therapies for arrhythmias. The first case is a 55-year-old female patient with sick sinus syndrome, who underwent permanent pacemaker implantation. She complained of dysphagia, dysphonia, and severe left arm pain and paralysis, and was diagnosed as having reflex sympathetic dystrophy. She lost her job and became depressed. Some sessions with physical and occupational therapists helped her recover from the depression. The second case is a 62-year-old female patient who was implanted with an implantable cardioverter-defibrillator (ICD). ICD was infected. However, local infection was controlled by intensive chemotherapy without reoperation. Her reactive depression was improved by peer-support from ICD support group. The third case is a 48-year-old female patient with hereditary long QT syndrome. She repeatedly complained of left arm phantom swelling after implantation with ICD. She was diagnosed as having transient hypochondriasis upon psychiatric consultation. Her psychiatric condition improved after explaining the result of thoracic computed tomography (CT), which was performed in the presence of a cardiac device representative (CDR). Although CT was not an ideal resolution of her hypochondriasis, this promoted her own awareness of the psychosomatic linkage. These three cases were didactic for cardiac device complications, which often require multidisciplinary psychosomatic approaches.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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