Mohanan Nair Krishna Kumar, Shafeeq Ali, Namboodiri Narayanan, Valaparambil Ajitkumar
Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
Pacing Clin Electrophysiol. 2021 Jun;44(6):1094-1096. doi: 10.1111/pace.14262. Epub 2021 May 24.
A 32-year-old lady was evaluated for recurrent episodes of palpitation. During one of the palpitation episodes a regular narrow QRS tachycardia was documented, and it got terminated with the administration of IV adenosine. The baseline 12 lead electrocardiogram (ECG) did not show any manifest preexcitation. There was no evidence of structural heart disease by echocardiogram. Patient underwent an electrophysiology (EP) study after informed consent. Quadripolar catheters were placed at the His region and right ventricular (RV) apex. A decapolar catheter was placed in the coronary sinus (CS) with CS 9, 10 dipoles at CS OS region and CS 1, 2 dipoles at CS distal region. A mapping & ablation catheter was positioned at right atrial (RA) appendage. Baseline atrial and ventricular pacing protocols could not be performed as both atrial and ventricular pacing were easily inducing a regular narrow QRS tachycardia. His refractory premature ventricular beats [PVBs] were delivered from RVRV apex and left ventricular [LV] free wall. Discordant responses were obtained. What is the mechanism?
一名32岁女性因心悸反复发作前来评估。在一次心悸发作期间，记录到规则的窄QRS心动过速，静脉注射腺苷后终止。基线12导联心电图（ECG）未显示任何明显的预激。超声心动图未发现结构性心脏病的证据。患者在签署知情同意书后接受了电生理（EP）检查。四极导管置于希氏区和右心室（RV）心尖。一根十极导管置于冠状窦（CS），CS 9、10偶极位于CS开口区，CS 1、2偶极位于CS远端区。一根标测与消融导管置于右心房（RA）心耳。由于心房和心室起搏均易诱发规则的窄QRS心动过速，因此无法进行基线心房和心室起搏方案。希氏不应期室性早搏[PVBs]由RV心尖和左心室[LV]游离壁发放。获得了不一致的反应。其机制是什么？
