Motté G, Grolleau R, Rebuffat G, Sebag C, Davy J M, Slama R
Arch Mal Coeur Vaiss. 1983 Feb;76(2):155-66.
Two patients were investigated for paroxysmal regular tachycardia with left bundle branch block centrifugation. A right-sided nodo-ventricular accessory pathway was demonstrated in both cases at electrophysiological investigation with His bundle recording and atrial and ventricular programd pacing techniques. However, the function of this pathway was different in the two cases. In the first case, there were no signs of an accessory pathway on the surface ECG in sinus rhythm but it could be unmasked by simple right atrial pacing at the same rhythm (widening of the QRS and shortening of HV from 40 to 25 ms). The tachycardias could be only initiated by ventricular extrastimulus. They showed major pre-excitation with left sided delay and a 1/1 atrio-ventricular response. There was no His potential before the ventriculogramme which retained the same configuration throughout the attack. The investigations also suggested the presence of a dual nodal pathway with the accessory pathway connected to the slow pathway. In the second case, the presence of an accessory pathway could be suspected from the appearance of the QRS complex in sinus rhythms. Tachycardia was initiated by an atrial extrastimulus with initially a first complex showing slightly more marked pre-excitation and a distinct His potential before the QRS but with a shorter HV interval than in sinus rhythm. Then the reciprocating tachycardia had appearances of major pre-excitation, left-sided delay and a 1/1 atrio-ventricular response. However, in contrast to the first case, all ventricular complexes were preceded by a His potential and the degree of pre-excitation was variable with a HV interval ranging from 0 to 15 ms. These two cases merit attention because of: --their points in common: nodal duality and an accessory pathway which was not atrio-ventricular (decremental conduction) but nodo-right ventricular, conducting well in the anterograde direction but more or less masked in sinus rhythm; the presence of the accessory pathway was clearly visible during reciprocating tachycardia; --the differences: in the first case the nodo-ventricular pathway formed part of the circuit of the reciprocating tachycardia which was antidromic: descending limb, the slow nodal pathway and then the accessory nodo-ventricular pathway; ascending limb, the His bundle and then the rapid nodal pathway. In the second case, the reciprocating tachycardia was entirely intranodal, the accessory pathway not being involved in the circuit but connected to it in parallel with the normal Hisian pathway.
对两名阵发性规则性心动过速伴左束支传导阻滞离心现象的患者进行了研究。在采用希氏束记录以及心房和心室程控刺激技术的电生理检查中，两例均证实存在右侧房室结-心室旁道。然而，该旁道在两例中的功能有所不同。在第一例中，窦性心律时体表心电图上无旁道迹象，但在相同心律下进行简单的右心房起搏可使其显现（QRS波增宽，HV间期从40毫秒缩短至25毫秒）。心动过速仅由心室期外刺激引发。它们表现为显著的预激，左侧延迟，房室1:1传导。心室波之前无希氏电位，整个发作过程中心室波形态保持不变。检查还提示存在双结径路，旁道与慢径路相连。在第二例中，窦性心律时QRS波群形态提示可能存在旁道。心动过速由心房期外刺激引发，最初第一个复合波显示预激稍明显，QRS波之前有明显的希氏电位，但HV间期比窦性心律时短。随后的折返性心动过速表现为显著预激、左侧延迟和房室1:1传导。然而，与第一例不同的是，所有心室复合波之前均有希氏电位，预激程度可变，HV间期范围为0至15毫秒。这两例值得关注，原因如下：——它们的共同点：结性双径路和一条并非房室性（递减传导）而是房室结-右心室性的旁道，顺行传导良好，但在窦性心律时或多或少被掩盖；在折返性心动过速期间旁道的存在清晰可见；——不同点：在第一例中，房室结-心室旁道构成了折返性心动过速的逆向传导环：下降支为慢结径路，然后是房室结-心室旁道；上升支为希氏束，然后是快结径路。在第二例中，折返性心动过速完全在结内，旁道不参与环路，但与正常希氏径路平行相连。
