Tanner Hildegard, Sakata Takao, Delacrétaz Etienne
Swiss Cardiovascular Center Bern, University Hospital, CH-3010 Bern, Switzerland.
Europace. 2008 Jan;10(1):110-1. doi: 10.1093/europace/eum240. Epub 2007 Nov 15.
We describe the case of a 16-year-old woman with a surgically corrected tetralogy of Fallot presenting with recurrent wide-QRS-complex tachycardia. The tachycardia could be induced and terminated with ventricular stimulation only. QRS morphology during sinus rhythm and tachycardia was identical and variable VA-conduction was observed. Mapping of the tachycardia showed that variations of HH intervals preceded VV intervals. Therefore, a mechanism involving re-entry within the bundle branches was suggested. However, detailed mapping showed cranial to caudal depolarization of the His bundle, leading to the diagnosis of atrioventricular node re-entrant tachycardia. The tachycardia was abolished by radiofrequency catheter ablation of the slow AV nodal pathway. We conclude that variable VA conduction can occur in patients with atrioventricular node re-entrant tachycardia. The atrial tissue is not always an integral part of the re-entrant circuit.
我们描述了一名16岁女性的病例，该患者法洛四联症已通过手术矫正，现出现反复发作的宽QRS波群心动过速。仅通过心室刺激即可诱发和终止该心动过速。窦性心律和心动过速期间的QRS形态相同，且观察到VA传导可变。心动过速标测显示，HH间期的变化先于VV间期。因此，提示存在一种涉及束支内折返的机制。然而，详细标测显示希氏束从颅侧向尾侧 depolarization，从而诊断为房室结折返性心动过速。通过射频导管消融慢房室结通路消除了心动过速。我们得出结论，房室结折返性心动过速患者可出现可变的VA传导。心房组织并不总是折返环路的组成部分。 （注：原文中“depolarization”这个词在中文语境下可能需要结合具体医学知识准确理解，这里暂保留英文，因为不清楚具体准确的中文表述。）
