Critelli G, Gallagher J J, Thiene G, Perticone F, Coltorti F, Rossi L
Eur Heart J. 1985 Feb;6(2):130-7. doi: 10.1093/oxfordjournals.eurheartj.a061827.
A case of permanent junctional reciprocating tachycardia with post-mortem documentation of an accessory atrioventricular pathway as the substrate of the arrhythmia is reported. Tachycardia had lasted for 15 years and showed a retrograde P wave (P') and R-P' longer than P'-R interval. The tachycardia circuit utilized a concealed posterior septal accessory pathway as the retrograde limb. Because the arrhythmia was disabling and unresponsive to pharmacological treatment, the patient underwent closed chest ablation of the His bundle. After the procedure, no anterograde or retrograde conduction over the normal conduction system was observed; anterograde conduction over the anomalous pathway showed decremental properties. Because of previous myocardial infarction, the patient developed a ventricular aneurysm and died suddenly 5 months after His bundle ablation. Histological examination of the heart revealed a group of tiny fibromuscular bundles joining the lower rim of the coronary sinus outlet to the summit of the interventricular septums; the anomalous atrioventricular connection pursued a sinuous, tortuous path. The geometrical disposition of the accessory pathway may have been responsible for the decremental properties of conduction observed during life.
报告了一例永久性交界性反复性心动过速病例，尸检证明存在一条房室旁路作为心律失常的基质。心动过速持续了15年，表现为逆行P波（P'），且R - P'长于P' - R间期。心动过速环路利用一条隐匿的后间隔旁路作为逆行支。由于心律失常导致功能障碍且对药物治疗无反应，患者接受了希氏束闭合性消融术。术后，未观察到正常传导系统的前向或逆向传导；异常旁路的前向传导表现为递减特性。由于既往心肌梗死，患者出现了室壁瘤，并在希氏束消融术后5个月突然死亡。心脏组织学检查发现一组微小的纤维肌束，连接冠状窦口下缘与室间隔顶部；异常房室连接走行蜿蜒曲折。旁路的几何布局可能是导致生前观察到的传导递减特性的原因。
