Echt D, Chandurkar S, Goldberg L, Levy M N
J Electrocardiol. 1980 Apr;13(2):199-203. doi: 10.1016/s0022-0736(80)80055-0.
A case of concealed bigeminy is presented in which two forms of extrasystolic complexes were evident on the ECG. One form (type B) appeared after a single conducted sinus beat, in a pattern of manifest bigeminy. The other form (type A) occurred after a sequence of more than one conducted sinus beat. The two configurations have previously been explained on the basis of different foci and mechanisms. Certain features of the ECG from our patient suggested that the two forms originated from a common site. An experimental model was developed in which the right ventricle of a dog was stimulated at sub- or suprathreshold voltages on alternate sinus beats to simulate concealed bigeminy. The ECG obtained during stimulation of a single site was remarkably similar to that recorded from the patient. We have proposed that the extrasystoles that occur after a compensatory pause may spread in a manner different from those that follow a basic cardiac cycle length. The different pattern of propagation is probably ascribable to the lengthening of the refractory period of the cardiac tissues by the compensatory pause.
本文报告一例隐匿性二联律病例，其心电图上可见两种形式的早搏复合波。一种形式（B型）出现在单个下传窦性搏动之后，呈显性二联律模式。另一种形式（A型）出现在一个以上下传窦性搏动序列之后。此前曾根据不同的起源部位和机制对这两种形态进行过解释。我们患者心电图的某些特征提示这两种形式起源于同一部位。构建了一个实验模型，在该模型中，以低于或高于阈值的电压交替刺激犬的右心室窦性搏动，以模拟隐匿性二联律。在刺激单个部位时获得的心电图与从患者记录的心电图非常相似。我们提出，代偿间歇后出现的早搏可能以与跟随基本心动周期长度的早搏不同的方式传播。传播方式的差异可能归因于代偿间歇导致心脏组织不应期延长。
