Nagashima Koichi, Watanabe Ichiro, Okumura Yasuo, Kaneko Yoshiaki, Sonoda Kazumasa, Kogawa Rikitake, Sasaki Naoko, Iso Kazuki, Takahashi Keiko, Kurokawa Sayaka, Nakai Toshiko, Ohkubo Kimie, Hirayama Atsushi
Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Pacing Clin Electrophysiol. 2016 Oct;39(10):1108-1115. doi: 10.1111/pace.12928. Epub 2016 Sep 23.
Although a ventriculoatrial interval (VAI) of ≤70 ms is used to distinguish atrioventricular nodal reentrant tachycardia from orthodromic atrioventricular reciprocating tachycardia (AVRT), a VAI of ≤70 ms is sometimes observed in cases of AVRT. The study aimed to evaluate the short VAI that is seen in AVRT and to understand its underlying mechanism.
Electrophysiologic studies of 46 consecutive patients with AVRT involving an accessory pathway (AP) were examined retrospectively.
AP was right sided in seven patients and left sided in 39. A VAI (interval from QRS onset to the earliest intracardiac atrial electrogram recorded by any mapping catheter during AVRT) ≤70 ms during AVRT (short VAI) was observed in eight patients: six with a left lateral AP and two with a left posteroseptal AP. During AVRT involving a left-sided AP, the QRS-V interval (from the earliest QRS onset to the local ventricular electrogram at a site which showed earliest atrial electrogram recorded from the coronary sinus catheter) was significantly shorter (37 ± 7 ms vs 54 ± 13 ms, P = 0.001) and supernormal conduction (QRS duration or the QRS-V interval shortening by ≥10 ms during AVRT) was more frequently seen (63% vs 6%, P = 0.02) in the short VAI group than in the normal VAI group. Furthermore, these parameters were shown to be determinants for short VAI.
A short VAI is sometimes observed during AVRT involving a left-sided AP. The short VAI may be caused by rapid propagation or supernormal conduction between the proximal Purkinje-muscle junction and basal left ventricular myocardium.
尽管心室-心房间期（VAI）≤70毫秒用于区分房室结折返性心动过速与顺向型房室折返性心动过速（AVRT），但在AVRT病例中有时也会观察到VAI≤70毫秒。本研究旨在评估AVRT中出现的短VAI，并了解其潜在机制。
回顾性检查了46例连续的涉及旁路（AP）的AVRT患者的电生理研究。
AP位于右侧的有7例，左侧的有39例。在8例患者中观察到AVRT期间VAI（从QRS波起始至AVRT期间任何标测导管记录到的最早心内房性电图的间期）≤70毫秒（短VAI）：6例为左侧旁道，2例为左后间隔旁道。在涉及左侧AP的AVRT期间，短VAI组的QRS-V间期（从最早的QRS波起始至冠状窦导管记录到最早房性电图部位的局部心室电图）明显更短（37±7毫秒对54±13毫秒，P = 0.001），并且超常传导（AVRT期间QRS波时限或QRS-V间期缩短≥10毫秒）在短VAI组中比正常VAI组更常见（63%对6%，P = 0.02）。此外，这些参数被证明是短VAI的决定因素。
在涉及左侧AP的AVRT期间有时会观察到短VAI。短VAI可能是由近端浦肯野-心肌连接与左心室基底部心肌之间的快速传导或超常传导引起的。
