Ajiki Kohsuke, Hayami Noriyuki, Kasaoka Yuji, Imai Yasushi, Fujiu Katsuhito, Murakawa Yuji
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Japan.
Int Heart J. 2007 Mar;48(2):253-9. doi: 10.1536/ihj.48.253.
Supraventricular tachycardia (SVT) was observed in a 13-year-old male patient with complex clinical features that included univentricular heart with single atrium, pulmonary atresia, and polysplenia syndrome. During electrophysiologic study, atrial burst stimuli reproducibly induced and terminated the SVT, while the occurrence of ventriculoatrial block did not interrupt the SVT. His bundle electrograms (HBEs) were recognized both in the anterior and posterior regions on the common atrioventricular (AV) valve annulus. The posterior His bundle activation was progressively delayed along with the shortening of atrial pacing cycle length until it finally lagged behind local ventricular activation. Thus, antegrade AV conduction was solely via the anterior AV node. In contrast, during the SVT, the earliest activation was observed in the posterior HBE. These observations suggested that the posterior AV node serves as an origin of the SVT and that two AV nodes were linked together possibly through a sling at the infra-Hisian level. Radiofrequency catheter ablation applied to the posterior HBE eliminated the SVT.
在一名13岁男性患者中观察到室上性心动过速（SVT），该患者具有复杂的临床特征，包括单心房单心室心脏、肺动脉闭锁和多脾综合征。在电生理研究期间，心房猝发刺激可重复性地诱发和终止SVT，而室房阻滞的发生并未中断SVT。在共同房室（AV）瓣环的前部和后部区域均识别出他的束电图（HBE）。随着心房起搏周期长度的缩短，后希氏束激动逐渐延迟，直至最终落后于局部心室激动。因此，顺行性房室传导仅通过前房室结。相反，在SVT期间，最早的激动出现在后HBE。这些观察结果提示后房室结是SVT的起源，并且两个房室结可能通过希氏束下水平的一条束带连接在一起。应用于后HBE的射频导管消融消除了SVT。
