Tajima T, Dohi Y
Pacing Clin Electrophysiol. 1982 Sep;5(5):741-7. doi: 10.1111/j.1540-8159.1982.tb02311.x.
The effects of a single intravenous infusion of 2mg/kg body weight disopyramide phosphate (DP) on the mode of initiation of reentrant supraventricular tachycardia were assessed in seven patients with Wolff-Parkinson-White (WPW) syndrome using bundle of His electrograms and the ventricular extrastimulus method. The delta wave disappeared in three patients after DP. However, retrograde conduction via the accessory pathway persisted even after DP administration in all patients. These effects contributed to the induction of reciprocating tachycardia after DP. The retrograde functional refractory period of the His-Purkinje system (HPS) and the effective refractory period of the accessory pathway were increased in all cases and contributed to the development of reentry HPS. After DP, the zone of reentry HPS widened in four cases (including a newly developed case) and remained unchanged in three cases. Reentrant supraventricular tachycardia zones widened in three cases; these widened reentrant supraventricular tachycardia zones were induced by the widened reentry HPS, that is, reentry HPS was followed by the reentrant supraventricular tachycardia. This study demonstrates that persistence of retrograde accessory pathway conduction and widened reentry HPS which might be dose-related after DP could be the retrograde determinants affecting the reentrant supraventricular tachycardia zone.
采用希氏束电图和心室期外刺激法，对7例预激综合征（WPW）患者单次静脉输注2mg/kg体重的磷酸丙吡胺（DP）后折返性室上性心动过速的起始方式进行了评估。DP给药后，3例患者的δ波消失。然而，在所有患者中，即使在给予DP后，经旁路的逆向传导仍持续存在。这些效应导致DP给药后诱发折返性心动过速。所有病例中，希氏-浦肯野系统（HPS）的逆向功能不应期和旁路的有效不应期均延长，并促成了HPS折返的发生。DP给药后，4例患者（包括1例新发病例）的HPS折返区增宽，3例患者的折返区保持不变。3例患者的折返性室上性心动过速区增宽；这些增宽的折返性室上性心动过速区是由增宽的HPS折返诱发的，即HPS折返继发折返性室上性心动过速。本研究表明，DP给药后可能与剂量相关的逆向旁路传导持续存在和HPS折返增宽可能是影响折返性室上性心动过速区的逆向决定因素。
