Lévy S, Berkovitz B V, Broustet J P, Faugère G, Valeix B, Chabrillat Y, Gatau-Pelanchon J, Gérard R, Bricaud H
Arch Mal Coeur Vaiss. 1983 Apr;76(4):421-9.
Asynchronous pacing at a rhythm slower than that of the tachycardia (underdrive) is an established procedure for the reduction of supraventricular tachycardia. Simultaneous or sequential stimulation depolarising two parts of the circuit (atrium and ventricle) has a greater chance of reducing the tachycardia than stimulation of a single chamber. Five patients with supraventricular tachycardia resistant to antiarrhythmic therapy were treated by sequential pacing in the underdrive mode. Electrophysiological investigations showed a bundle of Kent to be responsible for the ECG appearances of Wolff-Parkinson-White (3 cases) with retrograde conduction only (concealed WPW) in 2 cases. One patient was able to put a stop to his attacks by the application of a magnet over the pulse generator. In four patients, a newly designed pulse generator, based on this concept, was implanted with the property of automatic detection of tachycardia (defined as a heart rate faster than 150/min) triggering almost simultaneous pacing of the coronary sinus and right ventricle (sequential interval of 65 ms) in the asynchronous mode at 77 bpm. The results were reviewed with a follow up of 6 to 36 months. This pulse generator was shown to be effective in both the reduction and prevention of episodes of supraventricular tachycardia. Sequential double demand pacing is a valuable and useful method of treating reentrant tachycardias associated with the WPW syndrome or concealed Kent bundles. It provides an alternative to surgery when the effective refractory period of the Kent bundle is long. Present advances in the field of cardiac pacing will probably result in a widening of the indications for this mode of therapy.
以比心动过速慢的节律进行异步起搏（超速抑制）是降低室上性心动过速的既定方法。同时或序贯刺激使电路的两个部分（心房和心室）去极化，比单腔刺激更有可能降低心动过速。对5例对抗心律失常治疗无效的室上性心动过速患者采用序贯超速抑制模式起搏治疗。电生理检查显示，肯特束是导致预激综合征心电图表现的原因（3例），其中2例仅存在逆向传导（隐匿性预激综合征）。1例患者通过在脉冲发生器上放置磁铁终止了发作。在4例患者中，植入了一种基于该概念新设计的脉冲发生器，其具有自动检测心动过速（定义为心率超过150次/分钟）的特性，能在异步模式下以77次/分钟的频率触发冠状窦和右心室几乎同时起搏（序贯间期为65毫秒）。对结果进行了回顾，随访时间为6至36个月。结果表明，这种脉冲发生器在降低和预防室上性心动过速发作方面均有效。序贯双按需起搏是治疗与预激综合征或隐匿性肯特束相关的折返性心动过速的一种有价值且有用的方法。当肯特束的有效不应期较长时，它为手术提供了一种替代方法。心脏起搏领域目前的进展可能会导致这种治疗模式的适应证扩大。
