Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
Department of Cardiology, Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Denmark.
Heart Rhythm. 2014 May;11(5):871-6. doi: 10.1016/j.hrthm.2014.02.023. Epub 2014 Feb 28.
It is suggested that the adenosine resistance of retrograde fast pathway in slow-fast atrioventricular nodal reentrant tachycardia (AVNRT) confirms the participation of a concealed retrograde atrio-Hisian pathway rather than the conventional fast pathway in the arrhythmia circuit of slow-fast AVNRT.
To prospectively assess the retrograde fast pathway response to the intravenous administration of adenosine in patients with typical AVNRT and the control group.
Electrophysiological parameters and adenosine sensitivity of retrograde fast pathway were studied in 21 consecutive patients (18 women; mean age 57 ± 10 years) with slow-fast AVNRT and 24 patients (11 women; mean age 46 ± 16 years) as the control group.
Fifteen (71%) patients with AVNRT and 18 (75%) patients in the control group developed transient ventriculoatrial (VA) block after the intravenous administration of adenosine (P = .79). In patients with slow-fast AVNRT, female sex (P = .003), longer VA interval during right ventricular pacing (P < .001), and longer tachycardia cycle length (P < .001) predicted transient VA block after the intravenous administration of adenosine. In patients in the control group, a shorter VA interval during fixed rate right ventricular apical pacing (P = .009) and the presence of dual atrioventricular nodal physiology (P = .002) were associated with the adenosine resistance of the retrograde fast pathway.
The prevalence of the adenosine resistance of retrograde fast pathway's conduction is comparable between patients with and those without slow-fast AVNRT. This finding can be explained better by the existence of an insulated intranodal tract with Purkinje-like properties or a superior atrionodal connection to the nodo-Hisian region of the atrioventricular node rather than the presence of an atrio-Hisian pathway.
有研究表明，折返快径逆传不应答在快慢型房室结折返性心动过速（AVNRT）中提示隐匿性逆传房-希旁路的参与，而非传统快径在快慢型 AVNRT 折返环中起作用。
前瞻性评估静脉注射腺苷对快慢型 AVNRT 患者及对照组患者的逆传快径反应。
共入选 21 例连续快慢型 AVNRT 患者（18 例女性，平均年龄 57 ± 10 岁）和 24 例对照组患者（11 例女性，平均年龄 46 ± 16 岁），研究其电生理参数和逆传快径的腺苷敏感性。
AVNRT 组 15 例（71%）和对照组 18 例（75%）患者静脉注射腺苷后出现短暂的房室（VA）阻滞（P =.79）。在快慢型 AVNRT 患者中，女性（P =.003）、右心室起搏时 VA 间期更长（P <.001）和心动过速周长更长（P <.001）与静脉注射腺苷后出现短暂的 VA 阻滞相关。在对照组患者中，右心室心尖部固定频率起搏时 VA 间期更短（P =.009）和存在双房室结生理特性（P =.002）与逆传快径对腺苷无反应相关。
快慢型 AVNRT 患者与非快慢型 AVNRT 患者的逆传快径对腺苷的不应答发生率相似。隐匿性逆传旁路或至上性房室结的连接存在有髓鞘的结内通路或浦肯野样特性，而不是隐匿性房-希旁路的存在，可以更好地解释这种现象。
