Physiology of “Atypical” Atrioventricular Junctional Reentrant Tachycardia Occurring Following Radiofrequency Catheter Modification of the Atrioventricular Node
Physiology of “Atypical” Atrioventricular Junctional Reentrant Tachycardia Occurring Following Radiofrequency Catheter Modification of the Atrioventricular Node
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房室结射频导管改良后发生“非典型”房室交界折返性心动过速的生理学
DOI：
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发表时间：
1992
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影响因子：
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通讯作者：
A. Kadish
中科院分区：
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作者：
J. Goldberger;R. Brooks;A. Kadish
房室结导管改造后发生的非典型房室交界折返性心动过速 (AVJRT) 的生理学尚不明确。6 名接受射频电流导管改造房室结的患者在房室结改造前后出现诱导性非典型 AVJRT。典型 AVJRT 与非典型 AVJRT 的区别在于希束电图记录中心室心房 (VA) 时间 < 60 毫秒。其中 5 名患者在房室结导管改造后出现非典型 AVJRT。前路 AV 结修改后，有 6 名患者有典型 AVJRT，有 2 名患者有非典型 AVJRT，在修改前所有非典型 AVJRT 患者中记录到了先前未检测到的非典型 AVJRT，在修改后有 3 名非典型 AVJRT 患者，心动过速期间的 AH 间隔为 320 ± 52 毫秒。 AVJRT，修改前非典型 AVJRT 为 88 ± 33 毫秒，修改后非典型 AVJRT 为 172 ± 12 毫秒 (P − 0.0001)。典型 AVJRT 中的 AHJRA 比率为 4.1 ± 0.9，修改前非典型 AVJRT 中为 0.5 ± 0.2，以及 0.9 ± 0.2。改造后非典型 AVJRT 中的两名患者接受了进一步后路 AV 结改造，导致 VA 阻滞。一名改造后非典型 AVJRT 患者进行了进一步前路 AV 结改造，导致心脏传导阻滞。
The physiology of atypical atrioventricular junctional reentrant (achycardia (AVJRT) occurring following catheter modification of the AV node is poorly defined. Six patients undergoing radiofrequency current catheter modification of the AV node had inducible atypical AVJRT before or after AV nodal modification. Typical AVJRT was differentiated from atypical AVJRT by a ventriculoatrial (VA) time < 60 msec in the His‐bundle electrogram recording. Five of six patients had typical AVJRT and two had atypical AVJRT prior to AV nodal modification. Following anterior approach AV nodal modification, previously undetected atypical AVJRT was induced in four patients. Earliest retrograde atrial activation in the posterior septum was documented in all patients with atypical AVJRT prior to modification and in three four patients with atypical AVJRT following modification. The AH intervals during tachycardia were 320 ± 52 msec in typical AVJRT, 88 ± 33 msec in the premodification atypical AVJRTs, and 172 ± 12 msec in the postmodification atypical AVJRTs (P − 0.0001). The AHJRA ratios were 4.1 ± 0.9 in typical AVJRT, 0.5 ± 0.2 in the premodification atypical AVJRTs, and 0.9 ± 0.2 in the postmodification atypical AVJRTs (P = 0.0001). Two patients with postmodificafion atypical AVJRT underwent further posterior approach AV node modification that resulted in VA block. One patient with postmodification atypical AVJRT had further anterior approach AV nodal modification that resulted in heart block. The retrograde limb of the atypical AVJRT seen following anterior approach AV nodal modification is a posterior, slow pathway.