Tokuda Michifumi, Yamane Teiichi, Matsuo Seiichiro, Tokutake Kenichi, Yokoyama Kenichi, Hioki Mika, Narui Ryohsuke, Tanigawa Shin-Ichi, Yamashita Seigo, Inada Keiichi, Yoshimura Michihiro
Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
Heart Vessels. 2016 Feb;31(2):256-60. doi: 10.1007/s00380-014-0579-3. Epub 2014 Sep 16.
A 40-year-old female presented at our hospital because of heart palpitations. During an electrophysiological study, atrioventricular (AV) conduction showed dual AV nodal physiology. Three types of supraventricular tachycardia (SVT) were induced. The initiation of SVT was reproducibility dependent on a critical A-H interval prolongation. An early premature atrial contraction during SVT repeatedly advanced the immediate His potential with termination of the tachycardia, indicating AV node reentrant tachycardia (AVNRT). However, after atrial overdrive pacing during SVT without termination of the tachycardia, the first return electrogram resulted in an AHHA response, consistent with junctional tachycardia. The mechanism of paradoxical responses to pacing maneuvers differentiating AVNRT and junctional tachycardia was discussed.
一名40岁女性因心悸到我院就诊。在电生理研究中，房室传导显示出双房室结生理特性。诱发了三种类型的室上性心动过速（SVT）。SVT的起始具有可重复性，依赖于临界A-H间期延长。SVT期间的早期房性早搏反复提前即刻希氏束电位并终止心动过速，提示房室结折返性心动过速（AVNRT）。然而，在SVT期间进行心房超速起搏但未终止心动过速后，首次返回电图产生AHHA反应，符合交界性心动过速。讨论了区分AVNRT和交界性心动过速的起搏操作矛盾反应的机制。
