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A 71-year-old man complained of dyspnea on exertion and fatigue. He had persistent atrial fibrillation with enlarged left atrium, severe left ventricular dysfunction, systemic congestion and multivess...el coronary disease. An electrical cardioversion restored to sinus rhythm, maintained with amiodarone. Staged percutaneous coronary interventions were performed. Pulmonary vein isolation was performed 6 months after the last PCI. Consequently, the left ventricular systolic function and left atrial volume were well maintained, and symptoms improved from NYHA classⅢtoⅠ. The strategic order of therapeutic interventions is a key issue of decision making for successful outcome in performing contemporary, multidisciplinary therapies.
症例は71 歳男性．労作時息切れ，倦怠感を主訴とし精査目的に紹介となった．左房拡大（leftatrial volume index（LAVI）81.3 ml/m ^ 2）を伴う持続性心房細動，重度左室機能障害（ejectionfraction（EF）34％），体うっ血所見，冠動脈2枝病変（seg6：90％，seg7：90％，seg1：90％，seg3：慢性完全閉塞）を認め，虚血性心疾患に加えて頻脈誘発性心筋症を合併したため心不全が顕在化したと判断した．電気的除細動で洞調律復帰させ心不全に対する内服治療を行った．アミオダロンにて洞調律維持し，staged PCI にて冠血行再建（左冠動脈前下行枝，右冠動脈）を行った．最終PCI 後6 か月時点で確認冠動脈造影及び肺静脈隔離術を行った．左房拡大改善（LAVI 46.7ml/m ^ 2），左心機能改善（EF 56％），NYHAⅢ度からⅠ度への自覚症状改善が得られた．リズムコントロール，冠血行再建，抗心不全治療の集学的治療を行う上で，治療介入のタイミングを熟慮することが重要であった示唆に富む症例と考え報告する．show more
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