Sanchis J, López-Merino V, Sanjuán R, Morell S, Chorro F J, García-Civera R, Llácer A
Cardiology Service and Coronary Care Unit, Valencia University Clinic Hospital, Spain.
Eur Heart J. 1988 Sep;9(9):991-6. doi: 10.1093/oxfordjournals.eurheartj.a062604.
A study was made of nodal conduction times of atrial stimuli with fixed coupling intervals, in 23 patients divided into two groups according to their atrial stimulus test response: Group I (continuous AV node function curve; 17 cases) and Group II (dual AV node pathway; six cases). The stimulation protocol involved the delivery of 75 stimuli with a fixed coupling interval 20 ms greater than the effective refractory period (ERP) of the AV node (Group I) or fast pathway (Group II). The atrial coupling intervals (A1A2) and node conduction times (A2H2) were measured. An evaluation was made of the dispersion of intervals with range (R) and of the distribution of A2H2 times (X2 test). In both Groups, R (A2H2) was greater than R(A1A2) (P less than 0.05); R(A2H2) in Group II was greater than R(A2H2) in Group I (P less than 0.001). In Group I the distribution of A2H2 was non-normal in four cases and bimodal in five; in Group II the distribution was non-normal and bimodal in all cases. It is concluded that: (1) the AV node generates a dispersion in its conduction times in the vicinity of its ERP, although the nodal conduction curve is continuous; and (2) the so-called dual pathway may constitute an exaggeration of AV node response inhomogeneity.
对23例患者进行了研究，根据心房刺激试验反应将其分为两组，研究固定偶联间期下心房刺激的结传导时间：第一组（房室结功能曲线连续；17例）和第二组（房室结双径路；6例）。刺激方案包括发放75次刺激，其固定偶联间期比房室结（第一组）或快径路（第二组）的有效不应期（ERP）长20毫秒。测量心房偶联间期（A1A2）和结传导时间（A2H2）。用极差（R）评估间期离散度，并用卡方检验评估A2H2时间的分布。在两组中，R（A2H2）均大于R（A1A2）（P<0.05）；第二组的R（A2H2）大于第一组的R（A2H2）（P<0.001）。在第一组中，4例患者的A2H2分布呈非正态，5例呈双峰分布；在第二组中，所有患者的分布均呈非正态和双峰分布。得出以下结论：（1）尽管结传导曲线是连续的，但房室结在其ERP附近的传导时间会产生离散；（2）所谓的双径路可能是房室结反应不均匀性的一种夸大表现。
