Kremers M S, Wells P J, Black W H, Solodyna M A
Cardiology Division, University of Texas Southwestern Medical Center, Dallas 75235-9034.
Pacing Clin Electrophysiol. 1988 Sep;11(9):1310-4. doi: 10.1111/j.1540-8159.1988.tb03993.x.
The mechanism of ventricular tachycardia (VT) in postoperative tetralogy of Fallot has been ascribed to both reentry and triggered automaticity. We performed electrophysiologic studies on a patient with this condition and induced sustained uniform ventricular tachycardia by programmed extrastimulation. Pacing during the tachycardia at multiple cycle lengths from the right ventricular apex (RVA) and outflow tract (RVOT) produced constant but progressive fusion between the paced and tachycardia QRS. With termination of pacing, the last captured complex was unfused but coupled at the paced cycle length and then the tachycardia resumed at its intrinsic rate. Therefore, the VT was entrained. In addition, an area of slow conduction between the RVOT and RVA was demonstrated. These findings support a reentrant mechanism of this arrhythmia.
法洛四联症术后室性心动过速（VT）的机制被认为与折返和触发自律性有关。我们对一名患有此病的患者进行了电生理研究，并通过程控额外刺激诱发了持续性单形性室性心动过速。在心动过速期间，从右心室心尖（RVA）和流出道（RVOT）以多个周期长度进行起搏，在起搏的和心动过速的QRS波之间产生持续但渐进的融合。随着起搏终止，最后一个夺获的复合波未融合，但以起搏周期长度联律，然后心动过速以其固有频率恢复。因此，该室性心动过速被拖带。此外，还证明了RVOT和RVA之间存在缓慢传导区域。这些发现支持了这种心律失常的折返机制。
