Sakamoto Tamotsu, Fujiki Akira, Nakatani Yosuke, Sakabe Masao, Mizumaki Koichi, Inoue Hiroshi
Second Department of Internal Medicine, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
Heart Vessels. 2010 Mar;25(2):170-3. doi: 10.1007/s00380-009-1180-z. Epub 2010 Mar 26.
A 54-year-old man with prior inferior myocardial infarction suffered from monomorphic ventricular tachycardia (VT) with narrow QRS complex of 120 ms. During VT, a fragmented prepotential preceding QRS onset by 30 ms at the right ventricular posterior septum and a late diastolic potential preceding QRS onset by 70 ms at the infarcted posterior mitral annulus were recorded. Radiofrequency energy delivered to the late diastolic potential at the posterior mitral annulus eliminated VT. During sinus rhythm, the late diastolic potential shifted to the end of QRS complex and no Purkinje potentials were observed. Synchronized excitation of both ventricles from the posterior infarcted mitral annulus in this patient may make the QRS width during VT narrow, without involvement of the His-Purkinje system.
一名曾患下壁心肌梗死的54岁男性，出现了QRS波群时限为120毫秒的单形性室性心动过速（VT）。在室性心动过速期间，记录到右心室后间隔处QRS波起始前30毫秒有碎裂电位，梗死的二尖瓣后环处QRS波起始前70毫秒有舒张晚期电位。向二尖瓣后环处的舒张晚期电位施加射频能量消除了室性心动过速。在窦性心律时，舒张晚期电位移至QRS波群末端，未观察到浦肯野电位。该患者梗死的二尖瓣后环对两心室的同步激动可能使室性心动过速期间的QRS波宽度变窄，而未累及希氏-浦肯野系统。
