Weiss J, Brugada P, Roy D, Bär F W, Wellens H J
Pacing Clin Electrophysiol. 1983 Mar;6(2 Pt 1):260-7. doi: 10.1111/j.1540-8159.1983.tb04355.x.
In 18 consecutive patients with the Wolff-Parkinson-White syndrome undergoing electrophysiologic study, the ventriculo-atrial conduction time of right ventricular apical extrasystoles which advanced atrial activation during circus movement tachycardia was studied in relation to accessory pathway location. Accessory pathway location was determined by delta wave morphology during maximal pre-excitation, mapping of atrial activation during circus movement tachycardia and ventricular pacing, the effect of bundle branch block on ventriculo-atrial conduction time during circus movement tachycardia, and the effect of pacing from different sites in the atria on the stimulus-to-delta wave interval. In 7 patients with septal accessory pathways, ventriculo-atrial conduction time was similar during circus movement tachycardia and following right ventricular apical extrasystoles (mean difference 0 +/- 6 ms, range -5 to +10 ms). In contrast, in 11 patients with a left free wall accessory pathway, ventriculo-atrial conduction time increased by 46 +/- 15 ms (range 15 to 65 ms) following right ventricular apical extrasystoles. Therefore, measurement of the ventriculo-atrial conduction time of right ventricular extrasystoles during circus movement tachycardia provides an easy way to distinguish between septal and left free wall accessory pathways. This finding may be of particular use in determining the location of concealed bypass tracts.
在18例接受电生理研究的预激综合征患者中，研究了在折返性心动过速期间使心房激动提前的右心室心尖部期外收缩的室房传导时间与旁道位置的关系。旁道位置通过最大预激时的δ波形态、折返性心动过速和心室起搏期间心房激动的标测、束支阻滞对折返性心动过速期间室房传导时间的影响以及心房不同部位起搏对刺激至δ波间期的影响来确定。在7例有间隔旁道的患者中，折返性心动过速期间和右心室心尖部期外收缩后的室房传导时间相似（平均差异0±6毫秒，范围-5至+10毫秒）。相比之下,在11例有左侧游离壁旁道的患者中，右心室心尖部期外收缩后室房传导时间增加了46±15毫秒（范围15至65毫秒）。因此，测量折返性心动过速期间右心室期外收缩的室房传导时间为区分间隔旁道和左侧游离壁旁道提供了一种简便方法。这一发现对于确定隐匿性旁道的位置可能特别有用。
