Fujiki A, Yoshida S, Mizumaki K, Tani M, Tsuji H, Sasayama S
Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University.
J Cardiol. 1989 Mar;19(1):297-305.
Three patients with recurrent supraventricular tachycardia were presented. Atrial cycle length unchanged during the tachycardia with antegrade Wenckebach AH block was observed. When AH block occurred during tachycardia, the first AH interval was shorter than the subsequent one. The tachycardia was initiated and terminated by atrial extrastimulation beyond the atrial relative refractory period and the atrial activation sequence during the tachycardia was low to high. The induction of tachycardia was dependent on a critical AH interval. Ventriculoatrial conduction was not observed in patient 1 and 2. In patient 3 who had ventriculoatrial conduction, the tachycardia was initiated by the premature ventricular stimulation followed by double atrial response, and the tachycardia was terminated by the ventricular stimulation without atrial capture. In patient 1, verapamil (5 mg) prolonged the atrial cycle length during tachycardia and rapid intravenous injection of adenosine triphosphate (10 mg) terminated the tachycardia. Oral diltiazem (180 mg/day) suppressed the tachycardia in patients 2 and 3. These findings suggest that the mechanism of the tachycardia may be fast-slow type of AV nodal reentry in the upper portion of the AV node and this type of arrhythmia has a tendency to be incessant.
本文报告了3例复发性室上性心动过速患者。观察到在伴有前传文氏型房室阻滞的心动过速期间，心房周期长度无变化。当心动过速期间出现房室阻滞时，首个房室间期短于后续房室间期。心动过速由超过心房相对不应期的心房期外刺激诱发和终止，心动过速期间心房激动顺序为由下向上。心动过速的诱发依赖于一个关键的房室间期。在患者1和2中未观察到室房传导。在有室房传导的患者3中，心动过速由室性早搏刺激后出现双重心房反应诱发，心动过速由未夺获心房的心室刺激终止。在患者1中，维拉帕米（5 mg）使心动过速期间的心房周期长度延长，快速静脉注射三磷酸腺苷（10 mg）终止了心动过速。口服地尔硫䓬（180 mg/天）抑制了患者2和3的心动过速。这些发现提示，心动过速的机制可能为房室结上部的快慢型房室结折返，且这种类型的心律失常有持续发作的倾向。
