González-Torrecilla Esteban, Arenal Angel, Atienza Felipe, Osca Joaquin, García-Fernández Javier, Puchol Alberto, Sánchez Ana, Almendral Jesús
Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Heart Rhythm. 2006 Jun;3(6):674-9. doi: 10.1016/j.hrthm.2006.02.019. Epub 2006 Mar 6.
The difference between the first postpacing interval (PPI) after tachycardia entrainment from the right ventricular apex and the tachycardia cycle length (TCL) can be used as an index of proximity to the circuit.
The purpose of this study was to determine whether the response to entrainment of tachycardia during ventricular stimulation with correction for AV node delay is a useful, simple maneuver for differentiating AV nodal reentrant tachycardia (AVNRT) from orthodromic reciprocating tachycardia (ORT) using a concealed accessory pathway.
The study consisted of 193 consecutive patients who underwent electrophysiologic study and ablation of regular paroxysmal supraventricular tachycardia without preexcitation during sinus rhythm. Tachycardia entrainment was attempted through trains of 5 to 15 right ventricular apex pacing pulses. The increment in AV nodal conduction time in the first PPI was subtracted from the PPI-TCL difference (corrected PPI-TCL).
Electrophysiologic study demonstrated ORT in 84 patients and AVNRT in 109 patients. Transient entrainment was achieved in all but 12 patients. The mean corrected PPI-TCL difference was significantly shorter in 77 patients with ORT (66 +/- 27 ms) than in 104 AVNRT patients (151 +/- 28 ms; P <.0001). Patients with septal accessory pathways had shorter corrected PPI-TCL differences than patients with free-wall accessory pathways. The presence of a corrected PPI-TCL difference <110 ms identified all but one patient with ORT, and no patients with AVNRT had such a difference.
The return cycle after tachycardia entrainment by right ventricular apex stimulation with correction for AV node delay is a rapid, useful maneuver for differential diagnosis of AVNRT vs ORT in patients without preexcitation. The presence of a corrected PPI-TCL <110 ms accurately identified with high reliability those patients with ORT.
心动过速时从右心室心尖部进行超速起搏后第一个起搏后间期（PPI）与心动过速周长（TCL）之间的差值可作为判断与折返环距离的指标。
本研究旨在确定在心室刺激期间对心动过速进行超速起搏并校正房室结延迟后的反应，是否是一种利用隐匿性旁路将房室结折返性心动过速（AVNRT）与顺向型房室折返性心动过速（ORT）相鉴别的有用且简单的方法。
本研究纳入了193例连续的患者，这些患者在窦性心律时接受了电生理检查并消融了无预激的规则阵发性室上性心动过速。尝试通过5至15个右心室心尖部起搏脉冲序列进行心动过速超速起搏。从PPI-TCL差值中减去第一个PPI中房室结传导时间的增量（校正后的PPI-TCL）。
电生理检查显示84例患者为ORT，109例患者为AVNRT。除12例患者外，所有患者均实现了短暂的超速起搏。77例ORT患者的平均校正PPI-TCL差值（66±27毫秒）显著短于104例AVNRT患者（151±28毫秒；P<.0001）。间隔旁路患者的校正PPI-TCL差值比游离壁旁路患者短。校正后的PPI-TCL差值<110毫秒可识别除1例患者外的所有ORT患者，且无AVNRT患者有此差值。
右心室心尖部刺激心动过速并校正房室结延迟后的回波周期，是对无预激患者AVNRT与ORT进行鉴别诊断的快速、有用的方法。校正后的PPI-TCL<110毫秒可高度可靠地准确识别ORT患者。
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