Entrainment of ventricular tachycardia by atrial depolarizations.
Entrainment of ventricular tachycardia by atrial depolarizations.
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心房除极夹带室性心动过速。
DOI：
10.1016/0002-9149(85)90853-7
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发表时间：
1985
期刊：
影响因子：
--
通讯作者：
M. Josephson
中科院分区：
文献类型：
--
作者：
J. Almendral;C. Gottlieb;F. Marchlinski;A. Buxton;J. U. Doherty;M. Josephson
本文报告了四例快速心房起搏导致短暂性持续性室性心动过速（VT）的患者。4例中3例观察到心室融合。进行了以下新观察：（1）单次心房去极化导致心室融合和VT重置，而以更快速率心房起搏引起相同VT，但未检测到融合。这表明，在夹带过程中的融合可能是一种速率依赖性现象。(2)3例患者末次起搏与首次非起搏室性心动过速之间的间隔与起搏周期长度不同。有两种机制对此进行了解释：由于起搏波阵面而产生的每个夹带QRS的初始力，仅在末端力期间发生融合，最后一个夹带周期超过起搏周期长度，超过的量与QRS的非融合部分相关，以及假定折返回路中的延迟导致心动过速。(3)1例室性心动过速伴心房起搏，而心室起搏以相同速率导致终止，提示终止的“部位特异性”。它的结论是，夹带可以发生没有先前描述的标准作为它的特性，并可以观察到额外的现象刺激后，进一步支持折返VT的机制。
Four patients in whom rapid atrial pacing resulted in transient entrainment of a sustained ventricular tachycardia (VT) are reported. Ventricular fusion was seen in 3 of the 4. The following new observations were made: (1) A single atrial depolarization resulted in ventricular fusion and resetting of a VT, while atrial pacing at a faster rate entrained the same VT but without detectable fusion. This suggests that fusion during entrainment may be a rate-dependent phenomenon. (2) The interval between the last paced beat and the first nonpaced VT beat was different from the pacing cycle length in 3 patients. Two mechanisms accounted for this: the initial forces of each entrained QRS occurring as a result of the pacing wavefront, with fusion taking place only during the terminal forces, and the last entrained cycle exceeding the pacing cycle length by an amount related to the nonfused portion of the QRS, and delay in the presumed reentrant circuit responsible for the tachycardia. (3) One VT was entrained with atrial pacing while ventricular pacing at the same rate resulted in termination, suggesting “site specificity” for termination. It is concluded that entrainment can occur without the criteria previously described as characteristic of it and that additional phenomena may be observed after stimulation that further support reentry as the mechanism of VT.