Castellanos A, Zaman L, Fernandez P, Portillo B, Berkovits B V, Myerburg R J
Department of Medicine, University of Miami School of Medicine, Florida 33101.
Am J Cardiol. 1988 Apr 1;61(10):781-6. doi: 10.1016/0002-9149(88)91066-1.
The entrainment characteristics of orthodromic circus movement tachycardias occurring during autodecremental atrial and ventricular stimulation were studied in 9 patients with manifest Wolff-Parkinson-White syndrome. The phenomenon occurred in 34 of 38 episodes of tachycardia during autodecremental atrial stimulation. It was not seen in 4 episodes because the first impulse penetrating the circuit terminated the arrhythmia. Invariably, the HH and VV intervals were not equal to, but longer than, the stimulus-stimulus intervals, thus not fulfilling the definition of "classic" (constant cycle length) entrainment postulated by Okumura et al. Furthermore, the first 2 of the 3 diagnostic criteria were not demonstrated and the third only could be demonstrated in 7 episodes. Tachycardia termination was achieved in all 38 episodes. Entrainment occurred during autodecremental ventricular stimulation in 79 of 80 episodes, with the AA and H-H- intervals (when visible) being equal to the corresponding paced cycle lengths. Moreover, the intervals between the last paced ventricular beat and the first ventricular beat of the resumed tachycardia were invariably longer than the last stimulus-stimulus intervals. These characteristics were those which Okumura et al attributed to "concealed" entrainment. Tachycardia termination was achieved in 77 of 80 episodes. In summary: (1) autodecremental atrial pacing produced a specific form of entrainment that did not fulfill the "classic" definition of Okumura et al; (2) autodecremental ventricular pacing consistently produced "concealed" entrainment; and (3) autodecremental stimulation was very effective in terminating 115 of 118 (98%) of episodes of circus movement tachycardias.
对9例显性预激综合征患者进行自身递减心房和心室刺激时发生的顺向型折返性心动过速的拖带特征进行了研究。在自身递减心房刺激的38次心动过速发作中，有34次出现了这种现象。有4次未观察到该现象，因为首次穿透折返环的冲动终止了心律失常。HH间期和VV间期总是不等于刺激-刺激间期，而是比刺激-刺激间期长，因此不符合Okumura等人提出的“经典”（恒定周长）拖带的定义。此外，3项诊断标准中的前2项未得到证实，第3项仅在7次发作中得到证实。38次发作均实现了心动过速终止。在自身递减心室刺激时，80次发作中有79次出现拖带，AA间期和H-H间期（可见时）等于相应的起搏周长。此外，最后一次起搏心室搏动与恢复心动过速的首次心室搏动之间的间期总是长于最后一次刺激-刺激间期。这些特征是Okumura等人归因于“隐匿性”拖带的特征。80次发作中有77次实现了心动过速终止。总之：（1）自身递减心房起搏产生了一种不符合Okumura等人“经典”定义的特殊拖带形式；（2）自身递减心室起搏始终产生“隐匿性”拖带；（3）自身递减刺激在终止118次折返性心动过速发作中的115次（98%）时非常有效。
