[A case of Pickwickian syndrome treated by implantation of a cardiac permanent pacemaker]

A 41-year-old male was admitted to our hospital with congestive heart failure and bronchopneumonia. During hospitalization extreme sinus bradycardia, sinus arrest up to 6.2 seconds and high grade AV block were observed to occur simultaneously with apneic episodes of ECG monitoring. After that, a diagnosis of Pickwickian syndrome was made in this obese patient. In spite of weight reduction, change of sleep position and acetazolamide administration, obstructive sleep apnea and severe bradyarrhythmias were not improve. These severe bradyarrhythmias and ventricular tachyarrhythmias may be one cause of the not infrequent sudden deaths in patients with this Pickwickian syndrome. In addition to the tracheostomy, we propose that implantation of a cardiac permanent pacemaker should be selected for the bradyarrhythmias in association with the Pickwickian syndrome.