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| Abstract |
A 64-year-old man had demonstrated palpitations caused by paroxysmal atrial fibrillation (AF) documented by ambulatory electrocardiographic monitoring. Effectiveness of antiarrhythmic agent (disopyram...ide: 300 mg/day) was limited. Based on the gastrointestinal endoscopic findings, proton pump inhibitor (PPI : rabeprazole, 10mg/day)was administered to eliminate heart burn due to reflux esophagitis. Symptoms of paroxysmal AF and reflux esophagitis were confusing due to the anatomical proximity of the diseased organs and concomitant occurrence in the evening and when in a supine position. After the additional PPI therapy, not only was reflux esophagitis improved subjectively and endoscopically but also paroxysms of AF markedly reduced. Because esophagus is attached to left atrial posterior wall and the role of inflammatory process on the development of AF is highlighted,amelioration of reflux esophagitis by PPI may have been followed by the remarkable reduction of paroxysms of AF.
症例は64歳男性．動悸を主訴に来院した．ホルター心電図の結果より動悸は発作性心房細動によると考えられた．動悸は胸やけと前後して起こり夕食後や臥位で多かったため，この症例の心房細動は迷走神経依存型と考えられた．しかし従来の抗不整脈薬（ジソピラミド：300mg/日）の心房細動に対する抑制作用は十分ではなかった．内視鏡検査では逆流性食道炎も確認され胸やけはこれによると考えられたため，プロトンポンプ阻害剤（ラベプラゾール：10mg/日）を投与したところ，胸やけの改善とともに動悸も著減した．これは内視鏡所見の改善から考えると，逆流性食道炎による炎症機転が食道と隣接する左房へ波及していた可能性と，これがプロトンポンプ阻害剤によって抑制された可能性が考えられた．プロトンポンプ阻害剤自体の心臓迷走神経や心房筋への作用はなお不明ではあるが，少なくとも逆流性食道炎をともなう発作性心房細動に対して，プロトンポンプ阻害剤は補助的な治療効果を有すると考えられる．show more
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