Hansen James C, Kocheril Abraham G
University of Illinois at Chicago,Chicago, IL 60612, USA.
J Atr Fibrillation. 2008 Dec 1;1(4):141. doi: 10.4022/jafib.141. eCollection 2008 Dec.
A 64-year-old woman presented with palpitations. Her 24-hour Holter monitor revealed runs of presumed atrial fibrillation (AF). The patient was referred for EP study and AF ablation. At EPS, an anterograde A-H jump was noted. Spontaneous bursts of tachycardia were seen, consisting of sinus atrial beats with dual ventricular responses, each preceded by a His deflection. There was no atrial fibrillation during the study. Radiofrequency ablation of the slow AV node pathway was performed. There were no inducible tachycardias and no A-H jump following the ablation. The patient had no recurrence post-procedure. This case presents a rare example of simultaneous dual anterograde AV-nodal conduction. The conditions leading to this phenomenon include dual AVN pathways, markedly slowed conduction in the slow pathway, and lack of retrograde conduction up either pathway such that reentry was impossible. An irregular, narrow-complex tachycardia resulted, initially interpreted as AF. Slow-pathway ablation was curative.
一名64岁女性因心悸就诊。她的24小时动态心电图监测显示有疑似房颤（AF）发作。该患者被转诊进行电生理（EP）检查及房颤消融术。在电生理检查时，发现有前传A-H跳跃。可见自发的心动过速发作，由窦性心房搏动伴双心室反应组成，每次发作前均有希氏束电位偏转。检查期间未出现房颤。进行了慢房室结径路的射频消融术。消融术后未诱发出心动过速，也没有A-H跳跃。患者术后无复发。该病例展示了罕见的同时存在双前传房室结传导的例子。导致这种现象的条件包括双房室结径路、慢径路传导明显减慢以及两条径路均无逆向传导，从而无法形成折返。结果导致了一种不规则的窄QRS波心动过速，最初被误诊为房颤。慢径路消融术治愈了该疾病。
