シガ　ツヨシ   Shiga Tsuyoshi   志賀　剛    所属   医学部 医学科（東京女子医科大学病院）    職種   客員教授
言語種別	日本語
発表タイトル	Recovery of Left Ventricular Ejection Fraction and Ventricular Arrhythmias in Heart Failure Patients: Prospects of Wearable Cardioverter Defibrillator
会議名	第81回日本循環器学会学術集会
主催者	日本循環器学会
学会区分	全国規模の学会
発表形式	口頭
講演区分	シンポジウム・ワークショップ パネル（公募）
発表者・共同発表者	◎鈴木敦, 志賀剛, 菊池規子, 庄田守男, 萩原誠久
発表年月日	2017/03/19
開催地 （都市, 国名）	金沢市
学会抄録	第81回日本循環器学会学術集会　プログラム集 366
概要	Heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) are at a high risk of sudden cardiac death (SCD). Many of these patients are eligible to receive an implantable cardioverter defibrillator (ICD) for primary prevention of SCD. During follow‒up on optimal medical treatment, some of HF patients might experience a significant improvement in LVEF. The wearable cardioverter‒defibrillator (WCD) became available for 3 months in Japan as a means of protecting patients with newly‒diagnosed reduced LVEF against SCD until re‒evaluation of LVEF. We studied sixty‒one HF patients with less than 35% LVEF at the implantation of ICD for primary prevention of SCD. Among the 24 patients who were recovered more than 35% LVEF after 1 year, 14 (58%) maintained to be recovered long‒term (≥3years) after implantation. Four patients were delayed recovered at 3 years after ICD implantation. Delayed or long‒term recovered patients had significantly lower rate of appropriate ICD therapy (13% vs. 46%, p<0.05) and HF hospitalization (0% vs. 48%, p<0.05) than non‒recovered. Non‒recovered patients had significantly lower LVEF (23+/‒7% vs. 27+/‒7%, p<0.05) and longer corrected QT (459+/‒39 vs. 430+/‒46, p<0.05) at ICD implantation than delayed or long‒term recovered patients. The electrocardiographic characteristics may be associated with reverse remodeling and prevention of SCD. Then, we evaluated 11 patients with newly‒diagnosed HF, reduced LVEF and WCD. No patients experienced ventricular arrhythmia during WCD therapy. There was three patients with LVEF less than 35% after 3 months WCD therapy. In patients with newly‒diagnosed reduced LVEF without ventricular arrhythmia, it is important to determine the optimal timing of the ICD implantation.