Clinical, electrocardiographic and electrophysiologic observations in patients with paroxysmal supraventricular tachycardia.
Clinical, electrocardiographic and electrophysiologic observations in patients with paroxysmal supraventricular tachycardia.
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阵发性室上性心动过速患者的临床、心电图和电生理学观察。
DOI：
10.1016/0002-9149(78)90856-1
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发表时间：
1978
期刊：
影响因子：
--
通讯作者：
K. Rosen
中科院分区：
文献类型：
--
作者：
Delon Wu;P. Denes;F. Amat;R. Dhingra;C. Wyndham;R. Bauernfeind;P. Latif;K. Rosen
对 79 名无心室预激但有阵发性室上性心动过速记录的患者进行了分析。电生理学研究表明，50 名患者存在房室 (A-V) 结折返，9 名患者存在隐匿性结外通路折返，7 名患者存在窦房或心房折返，3 名患者存在异位自动性心动过速。10 名患者（包括 7 名心动过速不可诱发的患者）无法确定心动过速的明确机制。比较了诱发性心动过速最大的三个组的年龄、器质性心脏病的存在、心动过速发生率、心动过速期间的功能性束支传导阻滞以及心动过速期间 P 波和 QRS 波群的关系。 A-V 结折返的特点是心动过速期间狭窄的 QRS 波群和与 QRS 波群同时出现的 P 波。利用隐藏的结外通路的折返的特征是年轻、无器质性心脏病、心率快、心动过速期间存在束支传导阻滞以及心动过速期间 QRS 复合波之后的 P 波。窦房折返的特点是频发器质性心脏病、心动过速时 QRS 波群狭窄以及 QRS 波群前面出现 P 波。 总之，大多数患者阵发性室上性心动过速的机制是可以确定的。对这些患者的临床和心电图特征的观察应该可以预测心动过速的机制。
Seventy-nine patients without ventricular preexcitation but with documented paroxysmal supraventricular tachycardia were analyzed. Electrophysiologic studies suggested atrioventricular (A-V) nodal reentrance in 50 patients, reentrance utilizing a concealed extranodal pathway in 9, sinus or atrial reentrance in 7 and ectopic automatic tachycardia in 3. A definite mechanism of tachycardia could not be defined In 10 patients (including 7 whose tachycardia was not inducible). The three largest groups with inducible tachycardias were compared in regard to age, presence of organic heart disease, rate of tachycardia, functional bundle branch block during tachycardia and relation of the P wave and QRS complex during tachycardia. A-V nodal reentrance was characterized by a narrow QRS complex and a P wave occurring simultaneously with the QRS complex during tachycardia. Reentrance utilizing a concealed extranodal pathway was characterized by young age, absence of organic heart disease, fast heart rate, presence of bundle branch block during tachycardia and a P wave following the QRS complex during tachycardia. Sinoatrial reentrance was characterized by frequent organic heart disease, a narrow QRS complex and a P wave in front of the QRS complex during tachycardia.In conclusion, a mechanism of paroxysmal supraventricular tachycardia could be defined in most patients. Observations of clinical and electrocardiographic features in these patients should allow prediction of the mechanism of the tachycardia.