Head up tilt試験を用いた神経調節性失神（Neurally mediated syncope:NMS）の病型診断と治療戦略の検討

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Neurally mediated syncope (NMS) is an important cause of recurrent syncopal episodes. We performed head-up tilt testing (HUT) with isoproterenol provocation in 27 patients (10 males and 17 females) who were suspected of having NMS between 2001 and 2006 at Joetsu General Hospital. Of the 27 patients, 20 (5 males and 15 females; mean age, 57.7 years) had syncope; five of these (25%) had syncope due to bradycardia or cardiac arrest (cardioinhibitory type), 9 (45%) due to hypotension (vasodepressor type), and 6 (30%) due to bradycardia with hypotension (mixed type). We selected treatment methods based on the type of syncope. DDD pacemakers with a rate drop response algorithm were implanted in the patients with the cardioinhibitory type. β-blocking agents and disopyramide were administered to patients with the vasodepressor and mixed types, respectively. During the follow-up period,17 patients (85%)were syncope-free and two (cardioinhibitory type) had one episode of syncope. However, after adjustment of the pacemaker algorithm, they were syncope-free. One patient (cardioinhibitory type) died from an accidental fall. Careful documentation of history and HUT are necessary for the diagnosis and treatment of NMS. We believe that the prognosis of NMS is good if treatment is selected based on the type of syncope.
信州医学会の論文