Sato Daisuke, Otani Hajime, Noda Teppei, Ueyama Takanao, Iwasaka Junji, Park Haengnam, Yamamoto Yoshihiro, Minato Naoki, Iwasaka Toshiji
Second Department of Internal Medicine, Kansai Medical University, Moriguchi City, Japan.
Department of Thoracic and Cardiovascular Surgery, Kansai Medical University, Moriguchi City, Japan.
J Cardiol Cases. 2011 Apr 12;3(3):e143-e148. doi: 10.1016/j.jccase.2011.03.005. eCollection 2011 Jun.
An 84-year-old male had experienced palpitations. He was transported to our hospital for treatment of palpitations. A 12-lead electrocardiogram (ECG) showed regular tachycardia with a wide QRS complex of 153 bpm, and the P wave was not clear. The ECG after the tachycardia stopped showed a sinus rhythm, and there was a prolonged PR interval of 312 ms and complete right bundle branch block. We recorded a prolonged AH interval (235 ms) in electrophysiology study (EPS). As for the St-A interval (185 ms) by consecutive pacing from the right ventricular apex, it was short in comparison with the anterograde conduction. As a result of detailed EPS, we diagnosed the tachycardia as slow-fast atrioventricular nodal reentrant tachycardia. The anterograde conduction depended on the slow pathway (SP), and the fast pathway (FP) was considered to have only retrograde conduction. It was thought that a complete atrioventricular block been caused by the SP ablation. Therefore we carried out FP ablation with three-dimensional computed tomography and the EnSite NavX mapping system (St. Jude Medical, St Paul, MN, USA), which was superior in space resolution power, and were able to effect a radical cure without complications.
一名84岁男性曾经历心悸。他被送往我院治疗心悸。12导联心电图（ECG）显示规则性心动过速，QRS波群增宽，心率为153次/分，P波不清晰。心动过速终止后的心电图显示窦性心律，PR间期延长至312毫秒，并有完全性右束支传导阻滞。在电生理研究（EPS）中，我们记录到AH间期延长（235毫秒）。从右心室心尖部连续起搏时，St-A间期（185毫秒）与前向传导相比缩短。经过详细的EPS检查，我们将该心动过速诊断为慢-快型房室结折返性心动过速。前向传导依赖于慢径路（SP），快径路（FP）仅被认为有逆向传导。认为SP消融导致了完全性房室传导阻滞。因此，我们使用空间分辨率更高的三维计算机断层扫描和EnSite NavX标测系统（美国明尼苏达州圣保罗市圣犹达医疗公司）进行FP消融，得以实现根治且无并发症。
