Section of Cardiac Electrophysiology and Pacing, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Section of Cardiac Electrophysiology and Pacing, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
JACC Clin Electrophysiol. 2023 Mar;9(3):425-441. doi: 10.1016/j.jacep.2022.10.040. Epub 2023 Feb 22.
Junctional tachycardia (JT) is typically considered to have an automatic mechanism originating from the distal atrioventricular node. When there is 1:1 retrograde conduction via the fast pathway, JT would resemble the typical form of atrioventricular nodal re-entrant tachycardia (AVNRT). Atrial pacing maneuvers have been proposed to exclude AVNRT and suggest a diagnosis of JT. However, after excluding AVNRT, one should consider the possibility of an infra-atrial narrow QRS re-entrant tachycardia, which can exhibit features that resemble AVNRT as well as JT. Pacing maneuvers and mapping techniques should be performed to assess for infra-atrial re-entrant tachycardia before concluding that JT is the mechanism of a narrow QRS tachycardia. Distinguishing JT from typical AVNRT or infra-atrial re-entrant tachycardia has notable implications regarding the approach to ablation of the tachycardia. Ultimately, a contemporary review of the evidence on JT raises some questions as to the mechanism and source of what has traditionally been considered JT.
交界性心动过速（JT）通常被认为具有起源于房室结远端的自动机制。当存在通过快径 1:1 逆行传导时，JT 类似于典型的房室结折返性心动过速（AVNRT）。已经提出了心房起搏操作来排除 AVNRT 并提示 JT 的诊断。然而，在排除 AVNRT 之后，应该考虑到可能存在心房下部窄 QRS 折返性心动过速，其可能表现出类似于 AVNRT 以及 JT 的特征。在得出 JT 是窄 QRS 心动过速的机制之前，应该进行起搏操作和映射技术来评估心房下部折返性心动过速。区分 JT 与典型的 AVNRT 或心房下部折返性心动过速对于心动过速消融的方法具有显著的意义。最终，对 JT 的证据进行的现代综述提出了一些关于传统上被认为是 JT 的机制和来源的问题。
