Double atrial responses to a single ventricular impulse in long RP' tachycardia
Double atrial responses to a single ventricular impulse in long RP' tachycardia
复制标题
DOI：
10.1111/j.1540-8159.1996.tb06510.x
复制
发表时间：
1996-04-01
影响因子：
1.8
通讯作者：
Yasue, H
中科院分区：
文献类型：
--
作者：
Yamabe, H;Okumura, K;Yasue, H
长RP‘心动过速患者对单个室性冲动的双心房反应(DAR)已有报道。为明确DARS发生的决定因素，对8例长RP‘心动过速患者进行了检查。其中4例为伴慢传导隐匿性旁道的顺向型房室折返性心动过速(AVRT)，另4例为少见(快慢)型房室结折返性心动过速(AVNRT)。在窦性心律时进行程序化快速心室起搏，在心动过速时也进行快速心室起搏(即夹带)。检测快慢径的逆行有效不应期(ERP)和逆行最大1：1传导速度。在4例房室折返性心动过速患者中，1例在程序起搏和快速起搏、窦性心律和牵引性起搏时观察到DAR。在4例AVNRT中，1例仅在夹带时观察到DAR。长RP‘心动过速患者DARS的决定因素是：(1)存在两条不同的逆行传导通路；(2)逆行快、慢传导通路的ERP较短，通过这些途径发生1：1室房传导的最小起搏周期较短；(3)慢传导通路的关键传导延迟；(4)慢传导通路中预先存在的顺行单向传导阻滞或慢传导通路中因与先前的逆行冲动相撞而产生的顺行传导阻滞。
Double atrial responses (DARs) to a single ventricular impulse have been described in patients with long RP' tachycardia. To define the determinants for the occurrence of DARs, 8 cases with long RP' tachycardia were examined. The mechanism of long RP' tachycardia was the orthodromic atrioventricular reciprocating tachycardia (AVRT) involving a slow conducting concealed accessory pathway in 4 cases and uncommon (fast-slow) type of atrioventricular nodal reentrant tachycardia (AVNRT) in the other 4 cases. Programmed and rapid ventricular pacing was performed during sinus rhythm and also rapid ventricular pacing during tachycardia (i.e., entrainment). The retrograde effective refractory period (ERP) and the retrograde maximal 1:1 conduction rate of the fast and slow conducting pathways were examined. in 1 of the 4 cases with AVRT, DARs were observed during programmed and rapid ventricular pacing, performed during sinus rhythm and also during entrainment. In 1 of the 4 cases with AVNRT, DARs were observed only during entrainment. The determinants of DARs in cases with long RP' tachycardia were: (1) presence of two different retrogradely conducting pathways; (2) short ERP of the retrograde fast and slow conducting pathways and a short minimal pacing cycle length at which 1:1 ventriculoatrial conduction occurs via these pathways; (3) crucial conduction delay in the slow conducting pathway; and (4) preexisting antegrade unidirectional block in the slow conducting pathway or the antegrade block in the slow conducting pathway produced by collision with a previous retrograde impulse during entrainment.