Guize L, Meilhac B, Cabanis C, Di Mattéo J, Maurice P
Arch Mal Coeur Vaiss. 1978 Feb;71(2):159-66.
The authors report two cases of "true" consecutive double ventricular response caused by a single premature atrial stimulation; both were young men with Wolff-Parkinson-White syndrome. In both cases, the presence of a bundle of Kent was confirmed. The phenomenon of double ventricular response arising successively from the bundle of Kent and node-His pathway is rare, being mentioned in only two cases in the literature. It is only found when there is the combination of a good bundle of Kent, fair forward conduction, and a relative ventricle-His retrograde block. Amongst the other mechanisms for double ventricular repsonse, re-entry from branch to branch presents the most difficult differential diagnosis. From our observations, the forward characteristics of the spread through the bundle of His which always procedes the bundle of His which always precedes the second ventricular complex have been confirmed, especially in view of the freat variation in the position of this potential which can easily be explained by variations in intra-nodal conduction. In one of these cases, the atriogram, taken after the second ventriculogram, was provided by retrograde activity in the bundle of Kent.
作者报告了两例由单个房性早搏引起的“真正的”连续性双心室反应病例;两例均为患有预激综合征的年轻男性。在这两例中,均证实存在肯特束。肯特束和希氏束-浦肯野系统相继出现双心室反应的现象较为罕见,文献中仅提及两例。仅在存在良好的肯特束、适度的前向传导以及相对的心室-希氏束逆行阻滞时才会出现这种现象。在双心室反应的其他机制中,分支间折返最难鉴别诊断。根据我们的观察,通过希氏束的传导前向特征总是先于希氏束,且总是先于第二个心室复合波,这一点已得到证实,尤其是考虑到该电位位置的巨大变化,这很容易通过结内传导的变化来解释。在其中一例中,第二次心室造影后拍摄的心房造影是由肯特束的逆行活动提供的。