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Vol. 36, pp. 537ῒ544, 2008
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GPT 119IUl῍ LDH 215IUl῍ ALP 303IUl῍ gGTP 274IUl῍ BUN 16.2mgdl῍ Cr 0.79 mgdl῍
U. A 5.7 mgdl῍ Na 141 mEql῍ K 3.7 mEql῍ Cl
: amlodipine 5 mg῍ losartan 50
108 mEql῍ Mg 2.0 mgdl῍ Glu 105 mgdl 
mgday ῌ
 CRP 0.03 mg dl TSH 1.39 mU ml
atrovastatin 5 mgday ῌ
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Figure 1. Chest X-ray films and electrocardiograms at the first medical examination.
26
AF 1 Figure 2. Portable transtelephonic electrogram.
Portable transtelephonic electrogram can store 30 seconds of data per event.
This shows a portable transtelephonic electrogram during sinus rhythm.
Figure 3. Echocardiograms.
A: Parasternal long-axis view: IVSTd῎PWTdῌ12 mm῎14 mm, LVDd῎Dsῌ54 mm῎40 mm, and EFῌ51῍
B: Apical 3-chamber view: E῎Aῌ0.82, DcT ῌ 196 msec, and E῎E[ῌ9.5
27
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QRS tachycardia῍ ῌ
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Figure 4. Portable transtelephonic electrograph ῌCardiophone῍.
Portable transtelephonic electrograph ῌCardiophone῍ is a compact device ῌmass: 63ῒ24ῒ
106.5 mm; weight: 120 g῍. In use, hold cardiophone in the right hand, place the probe’s
electrodes to a point close to the heart, push
button, record an electrocardiogram, and
make a phone call to the host computer at the
hospital with the acoustic coupler held to
transmission part of the phone, which stores
the electrocardiogram and print it as soon as
the computer receives the electrocardiogram
over the phone.
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NSVT῍ wEῌ ῎
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Figure 5. Portable transtelephonic electrogram during palpitation.
Portable transtelephonic electrogram on the 1st day showed a wide QRS tachycardia
with a heart rate of 300 beatsΐmin during palpitation. Palpitation was severe; however,
the level of consciousness was clear. It lasted approximately 30 minutes.
28
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VT ! Vf "#$%&'(
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JKL@' wide QRS
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Figure 6. Portable transtelephonic electrogram while ICD activated.
Accelerated atrial conduction due to VT was observed.
29
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Figure 7. Portable transtelephonic electrogram while ICD activated.
30
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D) 56
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>῎ Circ J 2006; 70 ῌSuppl. VI῍; 1391ΐ1462.
)LM)NO 147 F)*PQR9@(/῍ 45
2῎ Josephson ME. Clinical Cardiac Electrophysi-
7῍
@L!) 62 F'E
ology, 2nd ed. Philadelphia ῒ London, Lea &
G+ 42.2ῑ
J)ῌ S!@(/῍ DiMarco
Febiger, 1993.
JP and Philbrick JT8῍ @A!T)*῍ .KUVW
3῎ Kannel WB, Abbott RD, Savarge DD and
"X.)YZ6@[
McNamara PM.
Epidemiologic features of
\G+'E 22ῑ>(/Uῌ chronic atrial fibrillation: The Framingham
]^_U
"῍ ,$?
Study. N Engl J Med 1982; 306: 1018ΐ1022.
!"#$PQR9G+`U
4῎ Wolf PA, Benjmin EJ, Belanger AJ, Kannel
2,Iῌ
WB, Levy D and D[Agostino RB.
Secular
K)῍ ab-cd῍ .@#$
trends in the prevalence of atrial fibrillation,
e/C%f0g-h6",$
the Framingham Study. Am Heart J 1996; 131:
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PRῐ 2005 W+X­®Y>῎ Circ J 2006.
!)ῌ
6῎ Shimada M, Akaishi M, Asakura K, Baba A,
!U2῍
Iwanaga S, Asakura Y, Miyazaki T, Mitamura
ƒ6@„K@…
H and Ogawa S.
Usefulness of the newly
J/UU2῍ †p98A{‡ˆ'B
developed transtelephonic electrocardiogram
‰(ŠCD῍ %‹OD8‚ŒL!/U
and computer-supported response system.
ῌ (I(῍ S!Ž@EFGHL!/U
Cardiol 1996; 27: 211ΐ217.
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8῎ DiMarco JP and Philbrick JT. Use of ambulatory electrocardiographic ῌHolter῍ monitoring.
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6
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=ž῎ Mœ­®῍ 2003; 80: 1945ΐ
ῌ῏῎῍
AF C%&
J
'ž(῍
Ann Intern Med 1990; 113: 53ΐ68.
31
544
῍ΐ῏῎
ῑ῔ῒῐ
ῌ
Abstract
Portable Transtelephonic Electrograph Identified
the Underlying Cause of Atrial Fibrillation
Hiromitsu Sekizuka1, Naoki Matsumoto2, Yukako Ishikawa1, Kihei Yoneyama1,
Satoshi Nishio1, Yoshiyuki Watanabe1, Shounosuke Ryu1, Keizou Osada1,
Ryouji Kishi1, Emi Nakano3, Hisao Matsuda3, Tomoo Harada3,
and Fumihiko Miyake1
A 45-year-old male felt faint while driving around 10:00 o[clock on October 12; after that, he su#ered
from palpitation. He was diagnosed as having atrial fibrillation ῌAF῍ from the results of 12-lead electrocardiography performed at the clinic near his house. He was referred to our hospital. From October 15, the
patient started to use portable transtelephonic electrograph ῌPTE῍. On the same day, PTE recorded and
transmitted the electrocardiograms several times due to palpitation occurring before sleep. After he was
relieved from approximately 30-minute palpitation, he went to sleep. PTE showed prolonged QRS duration
during palpitation. He had no history of syncope. However, he felt faint while driving. Accordingly, he was
suspected as having ventricular tachycardia ῌVT῍ and was admitted to our hospital for electrophysiological
study ῌEPS῍. On October 25, EPS induced sustained VT. On October 30, the dual chamber implantable
cardioverter defibrillator ῌICD῍ was implanted. At this point, the relationship between AF and VT was not
fully clarified. After admission, ICD was frequently used due to VT. The intracardiac electrocardiograms
showed greater intraventricular conduction shortening with increased pacing output. PTE, which was
recorded at the same time, demonstrated the onset of AF after nonsustained VT. We concluded that a
shorter intraventricular conduction time with increased pacing output triggered AF.
1 Division of Cardiology, St. Marianna University School of Medicine
2 Division of Pharmacology, St. Marianna University School of Medicine
3 Division of Cardiology, Kawasaki Municipal Tama Hospital
32

貧血および上腹部痛をともなう十二指腸隆起性病変