Weissenburger J, Dumoulin P, Juliard J M, Frank R, Kessler P, Michel P L, Rozensztajn L, Valty J
Arch Mal Coeur Vaiss. 1983 Jun;76(6):739-46.
A 15 year old boy presented with palpitations of sudden onset and termination over a two month period. The heart was clinically and radiologically normal. The electrocardiogramme showed sinus rhythm with a short PR interval (0,11 sec) and narrow QRS complexes (0,08 sec) associated with an intermittent escape accelerated idioventricular rhythm (AIVR). During an attack of palpitations a regular tachycardia (250/min) with wide QRS complexes of the same configuration as those of the AIVR (left side delay). The diagnosis of ventricular tachycardia was retained. Endocavitary electrophysiological recording demonstrated preexcitation of the right ventricle associated with accelerated nodal conduction explaining the narrow QRS complexes in sinus rhythm. The wide complex tachycardias initiated and terminated by paired ventricular stimulation were identical to the spontaneous attacks and were attributed to an antidromic reciprocating rhythm. The hypothesis of a rhythm arising from the accessory pathway is suggested. This would explain the identical configuration of the QRS complexes of the AIVR and of the antidromic reciprocating-rhythm and the disappearance of the AIVR after surgical section of the accessory pathway.
一名15岁男孩在两个月内出现突发突止的心悸。临床和放射学检查显示心脏正常。心电图显示窦性心律，PR间期短（0.11秒），QRS波群窄（0.08秒），伴有间歇性逸搏加速性室性自主心律（AIVR）。心悸发作时出现规则的心动过速（250次/分钟），QRS波群宽大，形态与AIVR相同（左侧延迟）。诊断为室性心动过速。心腔内电生理记录显示右心室预激伴加速的结传导，解释了窦性心律时QRS波群变窄的原因。由成对心室刺激引发和终止的宽QRS波群心动过速与自发发作相同，归因于逆向折返心律。提示存在由附加通路产生节律的假说。这可以解释AIVR和逆向折返心律的QRS波群形态相同，以及附加通路手术切断后AIVR消失的现象。
