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长RP间期心动过速。其机制是什么？

Long RP interval tachycardia. What is the mechanism?

作者信息

Jiménez-Díaz Javier, González-Marín María-Arantzazu, González-Ferrer Juan J, Higuera-Sobrino Felipe

机构信息

Unidad de Arritmias, Servicio de Cardiología, Hospital General de Ciudad Real, Ciudad Real, España.

Unidad de Arritmias, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, España.

出版信息

J Arrhythm. 2017 Jun;33(3):242-244. doi: 10.1016/j.joa.2016.06.004. Epub 2016 Aug 31.

DOI:10.1016/j.joa.2016.06.004
PMID:28607623
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5459351/
Abstract

A 41-year-old man with a history of tachycardia refractory to multiple antiarrhythmic drugs was sent to our institution. His 12-lead electrocardiogram demonstrated incessant narrow QRS complex tachycardia with negative waves in the inferior leads and long RP interval. Occasionally, the tachycardia terminated after a wave and then was restarted after a sinusal beat. An EP study was performed during tachycardia. Intracardiac electrograms during tachycardia and response to pacing maneuvers are shown. What is the tachycardia mechanism?

摘要

一名41岁男性，有多种抗心律失常药物治疗无效的心动过速病史，被送至我院。他的12导联心电图显示持续性窄QRS波群心动过速，下壁导联有负向波，RP间期长。偶尔，心动过速在一个a波后终止，然后在窦性搏动后重新开始。在心动过速发作期间进行了电生理检查。图中显示了心动过速发作时的心内电图及对起搏操作的反应。心动过速的机制是什么？

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b412/5459351/73d3c46c75ee/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b412/5459351/ee81d40d489f/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b412/5459351/73d3c46c75ee/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b412/5459351/ee81d40d489f/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b412/5459351/73d3c46c75ee/gr2.jpg

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本文引用的文献

1
Differences in ventriculoatrial intervals during entrainment and tachycardia: a simpler method for distinguishing paroxysmal supraventricular tachycardia with long ventriculoatrial intervals.心动过速时房室间期的差异：鉴别长房室间期阵发性室上性心动过速的一种更简单方法。
J Cardiovasc Electrophysiol. 2011 Aug;22(8):915-21. doi: 10.1111/j.1540-8167.2011.02020.x. Epub 2011 Mar 8.
2
First postpacing interval after tachycardia entrainment with correction for atrioventricular node delay: a simple maneuver for differential diagnosis of atrioventricular nodal reentrant tachycardias versus orthodromic reciprocating tachycardias.心动过速拖带后校正房室结延迟的首个起搏后间期：鉴别房室结折返性心动过速与顺向型房室折返性心动过速的简单方法
Heart Rhythm. 2006 Jun;3(6):674-9. doi: 10.1016/j.hrthm.2006.02.019. Epub 2006 Mar 6.
3
Differentiation of atypical atrioventricular node re-entrant tachycardia from orthodromic reciprocating tachycardia using a septal accessory pathway by the response to ventricular pacing.通过心室起搏反应，利用间隔旁道鉴别非典型房室结折返性心动过速与经房室结折返性心动过速。
J Am Coll Cardiol. 2001 Oct;38(4):1163-7. doi: 10.1016/s0735-1097(01)01480-2.
4
Diagnostic value of tachycardia features and pacing maneuvers during paroxysmal supraventricular tachycardia.阵发性室上性心动过速时心动过速特征及起搏操作的诊断价值
J Am Coll Cardiol. 2000 Aug;36(2):574-82. doi: 10.1016/s0735-1097(00)00770-1.