Ergül Yakup, İrdem Ahmet, Esen Osman, Güzeltaş Alper
Department of Pediatric Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey.
Turk Kardiyol Dern Ars. 2018 Jul;46(5):406-410. doi: 10.5543/tkda.2017.39888.
A 15-year-old female patient presented at the clinic with heart failure (HF). A 12-lead electrocardiogram showed a heart rate of 170 bpm; negative P waves in leads DII, DIII, aVF; and long RP tachycardia (LRPT). Echocardiography demonstrated a shortening fraction (SF) of 20%. An electrophysiology study during tachycardia revealed an atrial-His time of 52 milliseconds and a His-atrial interval of 295 milliseconds. During ventricular entrainment, the postpacing interval-tachycardia cycle length was measured at 225 milliseconds. There was a pseudo V-A-A-V response. These findings confirmed the diagnosis of atypical atrioventricular nodal re-entrant tachycardia (aAVNRT). Successful slow pathway cryoablation was performed with an 8-mm-tip cryocatheter. After 2 weeks, the SF was measured as 34%. During a 2-year follow-up period, no recurrence was observed. In conclusion, fast-slow aAVNRT should be a part of the differential diagnosis of incessant LRPT leading to HF. Cryoablation can be used successfully in cases of aAVNRT.
一名15岁女性患者因心力衰竭就诊于诊所。12导联心电图显示心率为170次/分钟；II、III、aVF导联P波阴性；长RP心动过速（LRPT）。超声心动图显示缩短分数（SF）为20%。心动过速时的电生理研究显示房-希氏束时间为52毫秒，希氏束-心房间期为295毫秒。心室超速起搏时，起搏后间期-心动过速周期长度测量为225毫秒。有假性V-A-A-V反应。这些发现证实了非典型房室结折返性心动过速（aAVNRT）的诊断。使用8毫米尖端冷冻导管成功进行了慢径冷冻消融。2周后，测量的SF为34%。在2年的随访期内，未观察到复发。总之，快慢型aAVNRT应作为导致心力衰竭的持续性LRPT鉴别诊断的一部分。冷冻消融可成功用于aAVNRT病例。
